Fluid Management of Acute Decompensated Heart Failure Sub... | NCT06898515

Status Module

Arms/Interventions Module

Arm Groups

Label	Type	Description	Intervention Names
Reprieve System	Experimental	Participants randomized to Reprieve System will receive personalized and optimized diuretic and saline infusion using the study device during the course of the treatment.	Device: Reprieve System
Optimal Diuretic Therapy (ODT)	Active Comparator	Participants randomized to ODT will be treated with guided diuretic titration, as recommended in the ESC guidelines on diuretic therapy	Drug: furosemide infusion
Registry	No Intervention	Participants will be treated per local site usual care.

Interventions

Name	Type	Description	Arm Group Labels	Other Names
Reprieve System	Device	The Reprieve System is a hospital bedside fluid management console designed to provide personalized and automated infusion of the IV diuretic furosemide and physiological saline in response to the patient's real-time urine output to safely and rapidly decongest patients suffering from Acute Decompensated Heart Failure.

Outcomes Module

Primary Outcomes

Measure	Description	Time Frame
Hierarchical composite/win-ratio	Freedom from 30-day CV mortality Freedom from HF Rehospitalization 30 days post-discharge Greater net sodium loss per 24 hours during treatment	1. up to 30 days from randomization, 2. up to 30 days from discharge, 3. up to 72 hours after randomization
Incidence of device/procedure-related adverse events (KDIGO stage 2 or greater AKI, CAUTI)	KDIGO stage 2 or greater AKI: ≥ doubling of serum creatinine or use of renal replacement therapy; CAUTI per CDC definition	initiation of randomized therapy through 72 hours following completion of randomized therapy

Secondary Outcomes

Measure	Description	Time Frame
Net sodium loss		per 24 hours at end of randomized therapy
Time to discharge readiness	Time from initiation of randomized therapy to when the participant becomes medically ready for discharge from a decompensated heart failure treatment standpoint

Eligibility Module

Eligibility Criteria

Inclusion Criteria:

Diagnosis of HF with expected hospitalization >24 hours, with >1 new or worsening symptom and >2 physical examination, laboratory, or invasive findings of HF, and receiving or with plans to receive a HF-specific treatment
≥10 lb. (4.5 kg) above dry weight as estimated by health care provider.
Current outpatient prescription for daily loop diuretic.
Participants ≥ 22 years of age able to provide informed consent and comply with study procedures.
Elevated risk of diuretic resistance, as indicated by at least one of the following: Baseline hypochloremia OR Urine output <1L in the 6 hours following IV loop diuretic >=40 mg furosemide equivalent OR Spot urine sodium <100 mmol/L 1-2 hours after IV loop diuretic >= 40 mg furosemide equivalent

Exclusion Criteria:

Urologic issues that would predispose the participant to a high rate of urogenital trauma or infection with catheter placement or known inability to place a Foley catheter.
Hemodynamic instability as defined by any of the following: sustained systolic blood pressure <90 mmHg for >15 minutes within the past 48 hours, use of IV vasopressors or inotropes within past 48 hours, and/or current or previous mechanical circulatory support within the last week.
Uncontrolled arrhythmias defined as sustained HR >130 beats/min for >10 minutes within the past 48 hours.
Severe lung disease with chronic home oxygen requirement >2L/min.
Acute infection with evidence of systemic involvement (e.g., clinically suspected infection with fever or elevated serum white blood cell count).
Estimated glomerular filtration rate (eGFR) <25 ml/min/1.73m2 (calculated with either MDRD or CKD-EPI) or current use of renal replacement therapy (RRT).
Significant left ventricular outflow obstruction, severe uncorrected complex congenital heart disease, known severe stenotic valvular disease, severe infiltrative or constrictive cardiomyopathy or other diagnosis that would make aggressive decongestion unsafe.
Current or recent (< 30 days) type I myocardial infarction (e.g., acute coronary syndrome such as NSTEMI or STEMI from plaque rupture), coronary artery bypass surgery, or stroke. An isolated troponin elevation (e.g., from volume overload or demand ischemia) is not a reason for exclusion.
Severe electrolyte abnormalities (e.g., serum potassium <3.0 mEq/L, magnesium <1.3 mEq/L or sodium <125 mEq/L). Note: These are based on baseline/screening labs. Participants whose electrolyte levels are repleted cannot be reassessed for inclusion in the trial.
Other concomitant disease or condition the investigator believes will make it difficult to follow instructions or comply with study procedures and/or follow-up visits, including expected prolonged hospitalization for reasons other than decongestive therapy
Currently enrolled in an interventional trial (observational studies are permitted).
Life expectancy less than 6 months.
Women who are pregnant or breastfeeding.