Diuretics vs. Afterload Reduction for Treatment of HeartLogic Alerts

This trial is comparing two approaches for managing early warning signs of worsening heart failure detected by a smart implanted heart device (HeartLogic alert): increasing diuretics (water pills) versus adding or adjusting afterload-reducing medication (sacubitril/valsartan) that reduces strain on the heart. The goal is to determine which approach better prevents hospitalization. **You may be eligible if...** - You have a Boston Scientific implanted heart device with HeartLogic monitoring enabled - You are not on dialysis and have reasonable kidney function - Your blood pressure is above 105 mmHg systolic - You are able to tolerate either treatment option **You may NOT be eligible if...** - Your kidney filtration rate is below 25 mL/min and you don't respond to diuretics, or you are on dialysis - You are currently experiencing worsening heart failure symptoms (increased breathlessness or fatigue) - You had a significant change in heart rhythm problems in the past 2 weeks - You are pregnant or planning to become pregnant - You are already receiving regular IV heart failure medications - You are scheduled for a heart transplant or ventricular assist device within 6 months Talk to your doctor to see if this trial is right for you.