POcus INTERvention for Tailoring Diuretic Strategy in Acute Decompensated Heart Failure

Exclusion Criteria

• •Patients under evaluation for heart transplantation or with prior heart transplantation.
• •Acute coronary syndrome as the primary cause of hospitalization.
• •Evidence of uncontrolled infection.
• •Cardiac surgery or percutaneous coronary or structural cardiac intervention within the previous 30 days.
• •Signs of hypoperfusion, defined as any of the following: mean arterial pressure \< 60 mmHg, capillary refill time \> 4 seconds, arterial lactate \> 2 mmol/L or venous lactate \> 2.5 mmol/L.
• •Acute pulmonary embolism (segmental or more proximal) as the primary cause of hospitalization.
• •Acute stroke.
• •Chronic kidney disease stage 5 (estimated glomerular filtration rate \< 15 ml/min/m²) or requirement for renal replacement therapy.
• •Liver cirrhosis with portal hypertension.
• •Known pulmonary disease with extensive parenchymal involvement, including interstitial lung disease, pulmonary metastases, prior pneumonectomy, lobectomy, or pleurodesis.
• •Severe hypokalemia (serum potassium \< 2.5 mmol/L).
• •Pregnancy or breastfeeding.
• •Refusal to participate in the clinical trial.