Study Objective: This research aims to compare two treatments for people with acute decompensated heart failure (ADHF). One treatment uses the Reprieve System, and the other uses Optimal Diuretic Therapy (ODT). The goal is to see if the Reprieve System is better at reducing fluid buildup in patients with ADHF. Three Key Points:

• The study involves hospitalized patients and lasts more than 24 hours.
• Participants need to have a prescription for a daily loop diuretic, a type of medicine that helps the body get rid of extra fluid.
• Those who join must be at least 22 years old and able to follow study procedures.

Eligibility: To participate, patients must be diagnosed with heart failure, gain more than 10 pounds (4.5 kg) above their usual weight, and show signs of being at risk for diuretic resistance, which means their body might not respond well to fluid-removing medications. Participants must not have conditions that make catheter placement unsafe, significant heart diseases, or severe lung problems. Additionally, they cannot be pregnant, have serious infections, or be in another clinical trial.