Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve System (FASTR-II) (IDE-G210258)

Inclusion Criteria:

1. Diagnosis of HF with expected hospitalization >24 hours, with >1 new or worseningsymptom and >2 physical examination, laboratory, or invasive findings of HF, andreceiving or with plans to receive a HF-specific treatment

2. ≥10 lb. (4.5 kg) above dry weight as estimated by health care provider.

3. Current outpatient prescription for daily loop diuretic.

4. Participants ≥ 22 years of age able to provide informed consent and comply withstudy procedures.

5. 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 IVloop diuretic >= 40 mg furosemide equivalent

Exclusion Criteria:

1. Urologic issues that would predispose the participant to a high rate of urogenitaltrauma or infection with catheter placement or known inability to place a Foleycatheter.

2. Hemodynamic instability as defined by any of the following: sustained systolic bloodpressure <90 mmHg for >15 minutes within the past 48 hours, use of IV vasopressorsor inotropes within past 48 hours, and/or current or previous mechanical circulatorysupport within the last week.

3. Uncontrolled arrhythmias defined as sustained HR >130 beats/min for >10 minuteswithin the past 48 hours.

4. Severe lung disease with chronic home oxygen requirement >2L/min.

5. Acute infection with evidence of systemic involvement (e.g., clinically suspectedinfection with fever or elevated serum white blood cell count).

6. Estimated glomerular filtration rate (eGFR) <25 ml/min/1.73m2 (calculated witheither MDRD or CKD-EPI) or current use of renal replacement therapy (RRT).

7. Significant left ventricular outflow obstruction, severe uncorrected complexcongenital heart disease, known severe stenotic valvular disease, severeinfiltrative or constrictive cardiomyopathy or other diagnosis that would makeaggressive decongestion unsafe.

8. Current or recent (< 30 days) type I myocardial infarction (e.g., acute coronarysyndrome such as NSTEMI or STEMI from plaque rupture), coronary artery bypasssurgery, or stroke. An isolated troponin elevation (e.g., from volume overload ordemand ischemia) is not a reason for exclusion.

9. Severe electrolyte abnormalities (e.g., serum potassium <3.0 mEq/L, magnesium <1.3mEq/L or sodium <125 mEq/L). Note: These are based on baseline/screening labs.Participants whose electrolyte levels are repleted cannot be reassessed forinclusion in the trial.

10. Other concomitant disease or condition the investigator believes will make itdifficult to follow instructions or comply with study procedures and/or follow-upvisits, including expected prolonged hospitalization for reasons other thandecongestive therapy

11. Currently enrolled in an interventional trial (observational studies are permitted).

12. Life expectancy less than 6 months.

13. Women who are pregnant or breastfeeding.