The Role of intraABDOminal Pressure and Point Of Care UltraSound to Guide Decongestive Therapy in Heart Failure

Significant pulmonary congestion reduction through lung ultrasound assessment (b-lines)

To evaluate the complete resolution of pulmonary congestion as assessed by ultrasound (B-lines) after the first 72 hours of intravenous diuretic treatment in the hospital ward, comparing the standard of care treatment group with the interventional group (intra-abdominal pressure and ultrasound). The degree of pulmonary tissue congestion will be quantified using clinical ultrasound. Eight quadrants (four left and four right) will be examined. A quadrant will be considered positive for pulmonary tissue congestion if three or more B-lines are detected. Minimum: 0 quadrants; Maximum 8 quadrants

Time frame: From time to randomization until the first 72 hours of endovenous loop diuretics treatment at the Internal Medicine ward

Significant intravascular congestion reduction through venous excess ultrasound score (VEXUS score)

To evaluate the significant reduction in intravascular congestion (inferior vena cava diameter and venous excess ultrasound protocol) after the first 72 hours of intravenous diuretic treatment in the hospital ward, comparing the standard of care treatment group with the interventional group (intra-abdominal pressure and ultrasound). VEXUS score * Grade 0: No congestion; inferior vena cava vein (IVC) diameter \< 2 cms * Grade 1: Mild congestion, IVC 2\> cms + any combination of normal or mildly abnormal waveforms of doppler veins explored. * Grade 2: Moderate congestion, IVC \> 2 cms + at least one severely abnormal pattern of doppler veins explored. * Grade 3: Severe congestion, IVC \> 2cms + two or more severely abnormal waveforms of doppler veins explored. Minimum 0 points; Maximum 3 points

Time frame: After the first 72 hours of endovenous loop diuretic treatment

Total diuresis response

To evaluate the diuretic response (total urine volume/total dose of furosemide administered) after the first 72 hours of intravenous diuretic treatment in the hospital ward, comparing the standard treatment group with the intervention group (intra-abdominal pressure and ultrasound).

Time frame: After the first 72 hours of endovenous loop diuretic treatment

Total dose of diuretic treatment

To compare the days and doses of intravenous loop diuretics and hydrochlorothiazide used during the first 72 hours of hospitalization between the standard treatment group and the intervention group.

Time frame: After the first 72 hours of endovenous loop diuretic treatment

Number of patients treated for worsening heart failure

Differences in heart failure worsening (defined as the need for intravenous loop diuretic treatment after hospital discharge, whether in a day hospital, emergency department, or due to new hospital admissions at 30 and 90 days) between the two groups.

Time frame: From date of discharge until 30-days post-hospitalization visit. From date of discharge until 90-days post-hospitalization visit. (cut-off period 1-year)

Total number of patients with cardiovascular death

Differences in cardiovascular death incidence

Time frame: From date of discharge until the date of cardiovascular death (cut-off period 1 year)

guided directed medical therapy (GDMT)

Prevalence of GDMT prescribed at discharge according to left ventricular ejection fraction and actual heart failure guidelines

Time frame: From date of admission up to discharge, from date of discharge up to 30 days after and from date of discharge up to 90 days (cut-off period 1-year)

length of stay

Differences in length of stay between both arms

Time frame: From date of randomization until date of discharge (cut-off period 4 weeks)