Congestive symptoms are the primary cause of hospitalizations in heart failure (HF), and diuretics remain the cornerstone of their management. However, clinical practice varies widely due to a lack of a reliable measure of congestion guiding diuretic use. Consequently, many HF patients are discharged prematurely without adequate decongestion, leading to increased readmissions and mortality. Peripheral venous pressure (PVP) has emerged as a promising noninvasive measure of vascular congestion. This study will enroll 650 patients aged 18-99 years admitted with de novo or acutely decompensated chronic HF. In the standard care arm, diuretic dosing and discharge decisions will be at the physician's discretion. In the PVP-guided arm, the goal is to maintain a PVP of <9 mmHg, with diuretic dosing adjusted based on daily PVP changes and urine output. The primary outcome is a composite of all-cause mortality, hospitalizations, and emergency department visits, with secondary outcomes including cardiovascular mortality and HF-related readmissions. We hypothesize that PVP-guided diuretic therapy will provide more precise and effective decongestion than standard care, reducing rehospitalizations and mortality. In conclusion, this study will offer valuable insights into the relationship between diuretic therapy, vascular congestion, and cardiac and renal outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT06495892