Treatment With the Ketone Body 3-hydroxybutyrate in Patients With Acute Heart Failure

Inclusion Criteria:

• Hospitalized with worsening HF or de novo diagnosis of HF
• LVEF < 50%
• Treatment with intravenous loop diuretics during the hospitalization and/or increaseddosage of oral diuretics.

Exclusion Criteria:

• Cardiogenic shock
• Systolic Blood Pressure <85 mmHg
• Acute myocardial infarction other than type II <5 days prior to randomization *
• Severe uncorrected cardiac valve disease
• Expected or possible need for hemodialysis as judged by the investigator
• Ongoing inotropic treatment
• Possible need for advanced heart failure treatment (LVAD, heart transplantation) asjudged by the investigator.
• Ongoing, severe infection
• Severe respiratory distress (SAT<90% or RF> 24/min or receiving more than 2 l O2/minor intubated)
• Atrial Fibrillation with heart >120 beats per minute
• Inability to cooperate to or accept oral intake of food, including presence of majorgastrointestinal discomfort.
• If suspected or confirmed acute myocardial infarction as cause of acute heartfailure, patients can be recruited 5 days after hospitalization in the absence ofmalignant arrhythmias (e.g. ventricular tachycardia) or clinically significantresidual angina pectoris.