Acute decompensated heart failure, a constellation of dyspnea, edema, and fatigue due to volume overload, accounts for the high healthcare costs, projected to increase from $21 billion in 2012 to $70 billion in 2030 [1–4]. Therapies such as diuretics and ultrafiltration (UF) have been explored to target volume overload in patients with HF with reduced ejection fraction (HFrEF). Decongestion with diuretics has proven benefits in terms of decreasing symptoms and HF-related hospitalizations [5]. However, continuous or repeated diuretic use has been linked with decremental responses and increased resistance.
