This study will enroll participants who are hospitalized with decompensated heart failure. Heart failure is a condition in which the heart is not able to pump blood efficiently and as a result fluid can build up. This study is testing an investigational, not yet approved for commercial use by the Food and Drug Administration (FDA) device called the Repreive DMS. The Repreive DMS is an instrument designed to automatically administer medications called diuretics to optimize fluid removal and improve your symptoms of heart failure. This study has a randomized arm in which participants will be randomly assigned to treatment with the Repreive DMS system or standard of care treatment referred to as Optimal Diuretic Therapy. You have a 50:50 chance of being assigned to either arm. There is also a registry arm for participants who do not wish to participate in the randomized part of the study. The registry involves collecting data from your standard treatment. The randomized study will last about 13 weeks and involved up to 9 visits. The Repreive DMS involves infusing medication through an IV (intravenous or in the vein) and collecting urine via a foley catheter, which is placed in your bladder. Some of the other procedures involved in this study include physical exams, blood work, urine studies, hearing test, and medication administration.