SCD for CRS in Congestive Heart Failure (CHF) (No Left Ventricular Assist Device)

Inclusion Criteria

• •Primary hospitalization for acute decompensated chronic systolic heart failure as defined:
• •* Left ventricular ejection fraction ≤35% as confirmed by baseline imaging procedure.
• •* New York Heart Association (NYHA) class III or IV chronic (≤ 90 days) systolic heart failure, with failure to respond to optimal medical therapy (beta blocker, Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARB) or valsartan/sacubitril, aldosterone antagonist, unless not tolerated or contraindicated, and loop diuretic, as needed) for 45 of the last 60 days.
• •Baseline Estimated Glomerular Filtration Rate (eGFR)\*\* ≥ 40 ml/min/1.73 m2 (baseline defined as the highest known eGFR within 90 days of study enrollment)
• •Worsening renal failure (WRF), defined for the purposes of this study as increase serum creatinine ≥ 0.5 mg/dL from baseline (baseline defined as the lowest known serum creatinine within 90 days of study enrollment)
• •Cardiorenal syndrome is the most likely explanation for WRF
• •Persistent signs and /or symptoms of congestion (peripheral edema, dyspnea, pulmonary rales, neck vein distension) despite optimal medical therapy including intravenous diuretic therapy and an estimated need for greater than 5 kg. of fluid removal. For the purposes of this study, optimal intravenous diuretic therapy is defined as:
• •* Furosemide equivalent total daily dose of 240 mg (furosemide 40mg=1mg bumetanide)
• •* Furosemide equivalent dose given either as a single or multiple intravenous bolus or continuous infusion
• •* A furosemide equivalent total daily dose \<240 mg if the dose has resulted in \>3000 ml urine output/24 hours