Heart failure is a chronic condition that causes congestion and frequent hospitalizations. Diuretic doses are usually adjusted based on clinical judgment without an objective measure of response. This study will test the feasibility of using point-of-care urine sodium measurements to guide up-titration or down-titration of loop diuretics in ambulatory patients with heart failure.
Participants will be assigned to one of three groups based on congestion status. Groups 1 and 2 will be randomized 1:1 to natriuresis-guided therapy or standard care. Group 3 will be observational. The 90-day pilot trial will evaluate feasibility, clinical outcomes, and usability of a urine sodium-guided titration strategy.
Age ≥18 years
Diagnosis of heart failure according to the Universal Definition
Use of loop diuretics
Residing in VCH or PHC regions
eGFR <20 mL/min/1.73m²
Renal replacement therapy
High-risk clinical status requiring hospitalization
Inability to consent or perform required urine sampling