Clinical Research Directory

Inclusion Criteria: 1. Age \>18 years 2. Hospitalized for ADHF as the primary diagnosis, meeting both of the following: 1. ≥1 documented symptom of new or worsening heart failure (dyspnea, fatigue, decreased exercise tolerance, or symptom of end-organ hypoperfusion). 2. Objective evidence of ADHF, defined as either: i. ≥2 physical signs (edema, ascites, pulmonary rales/crackles, increased JVP, S3 gallop, rapid weight gain due to fluid retention), OR ii. ≥1 physical sign AND ≥1 laboratory finding indicative of ADHF (BNP \>500 ng/L or NT-proBNP \>2000 ng/L if sinus rhythm, or BNP \>750 ng/L or NT-proBNP \>3000 ng/L if atrial fibrillation, radiological/ultrasound evidence of pulmonary congestion, echocardiographic sign \[VCI \>2.1 cm, LVOT VTI \<15 cm, E/e' \>14, D-dominant pulmonary venous inflow pattern\], or invasive evidence \[CVP \>12 mmHg, PCWP \>18 mmHg, CI \<2.2 L/min/m2\]). 3. Treatment with ≥40 mg IV furosemide (or equivalent) 4. Enrolment within 24 hours of admission 5. Ability to provide informed consent Exclusion Criteria: 1. Requirement at admission for ICU-level care, or IV inotropic/vasopressor therapy for ADHF. 2. Na+ \<125 mmol/L or Na+ \>145 mmol/L. 3. End-stage chronic kidney disease on chronic dialysis or eGFR \<15 mL/min/1.73 m2 4. Any condition which would make participation unsafe or substantially affect protocol adherence, as judged by investigator.