Urine Sodium-Driven Diuretic Adjustment Strategy in Acute Decompensated Heart Failure

Patients will be randomized into one of three groups: 50 micromolar natriuresis, 85 micromolar natriuresis, and standard of care. The natriuresis arms will have urine sodium assessed two to four hours administration of intravenous diuretics. If the natriuretic response is inadequate they will immediately receive a higher dose of diuretic. This process will be repeated for the first 72 hours of admission.

Inclusion criteria

• The study will target adults 18 years of age or older admitted to Lakeland Regional Medical Center who:

• Have a primary diagnosis of acute decompensated heart failure, and
• Have at least one of the following signs of hypervolemia:

• Bilateral lower extremity pitting edema
• Jugular venous distension
• Hepatojugular reflex
• Crackles on pulmonary exam, or
• Chest x-ray demonstrating pulmonary edema or pleural effusions

Exclusion criteria

• Exclusion criteria include:

• Admission to the intensive care unit
• Presence of ST-elevated myocardial infarction
• Presence of type 1 non-ST elevated myocardial infarction
• Dyspnea primarily due to non-cardiac cause as judged by the emergency medicine physician or admitting physician
• Use of supplemental oxygen totaling at least 3 L per minute or greater at baseline
• Anuria
• End-stage renal disease per KDIGO criteria
• Dialysis use