The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure (AHF) and signs of volume overload. The study was an international, multicenter, open-label, pragmatic, 2-phase trial comparing the current standard of care with a standardized diuretic protocol that included urinary sodium to guide therapy. The primary endpoint was natriuresis after 1 day, and secondary endpoints included cumulative natriuresis and diuresis after 2 days, length of stay, and in-hospital mortality. Four hundred one patients from 29 centers in 18 countries were included. The protocol arm showed significantly higher natriuresis and diuresis after 1 and 2 days compared to the standard of care arm. The protocol arm also had a shorter length of stay, but in-hospital mortality was low and did not differ between the two arms. The study concluded that a standardized natriuresis-guided diuretic protocol is feasible, safe, and effective in improving diuretic response and reducing length of stay in patients with acute heart failure.The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure (AHF) and signs of volume overload. The study was an international, multicenter, open-label, pragmatic, 2-phase trial comparing the current standard of care with a standardized diuretic protocol that included urinary sodium to guide therapy. The primary endpoint was natriuresis after 1 day, and secondary endpoints included cumulative natriuresis and diuresis after 2 days, length of stay, and in-hospital mortality. Four hundred one patients from 29 centers in 18 countries were included. The protocol arm showed significantly higher natriuresis and diuresis after 1 and 2 days compared to the standard of care arm. The protocol arm also had a shorter length of stay, but in-hospital mortality was low and did not differ between the two arms. The study concluded that a standardized natriuresis-guided diuretic protocol is feasible, safe, and effective in improving diuretic response and reducing length of stay in patients with acute heart failure.