[Pendahuluan: Acute decompensated heart failure (ADHF) adalah penyebabutama rawat inap di RS karena morbiditas dan mortalitasnya yang tinggi.Perubahan metabolisme, pengaruh kongesti sistemik pada gastrointestinal, danefek samping terapi medikamentosa ADHF menyebabkan pasien ADHF rentanmengalami malnutrisi. Perbedaan faktor risiko ADHF juga mempengaruhi tatalaksana nutrisi. Tata laksana nutrisi yang adekuat sesuai dengan faktor risiko dankondisi klinis dibutuhkan untuk mencegah malnutrisi, menurunkan morbiditas danmortalitas.Presentasi Kasus: Pasien dalam serial kasus ini adalah dua perempuan dan dualaki-laki berusia 32–62 tahun dengan ADHF dan berbagai faktor risiko. Pasienpertama dengan diabetes melitus tipe 2, pasien kedua dengan dilatedcardiomyopathy, pasien ketiga dengan hipertensi, sedangkan pasien keempatdengan stenosis aorta. Target kebutuhan energi keempat pasien adalah sebesar130–140% kebutuhan energi basal yang dihitung dengan Harris-Benedict. Targetpemberian protein sebesar 0,8–1,4 g/kg BB/hari, kebutuhan lemak 25% darienergi total dengan komposisi lemak sesuai therapeutic lifestyle changes.Kebutuhan natrium 2400 mg/hari dengan restriksi cairan rata-rata sebesar 1500mL/hari. Pemberian mikronutrien dan nutrien spesifik berupa vitamin Bkompleks, C, B12, asam folat, seng, dan omega 3 disesuaikan dengan kondisipasien. Hasil: Pada keempat pasien didapatkan perbaikan kondisi klinis dan kapasitasfungsional.Kesimpulan: Tata laksana nutrisi yang adekuat pada pasien ADHF sesuai dengan faktor risiko dan kondisi klinis dibutuhkan untuk perbaikan outcome, menurunkan morbiditas dan mortalitas., Background: Acute decompensated heart failure (ADHF) is a leading cause forhospitalization due to its high morbidity and mortality. Metabolic changes,congestion effects on gastrointestinal, and side effects of therapy result inincreased risk of malnutrition in ADHF patients. Various risk factors and clinicalstatus also have great impact on nutritional management. An adequate nutritionalmanagement based on risk factor and clinical status is required to preventmalnutrition, reduce morbidity and mortality. Case Presentation: Two female and two male patients were included in this caseseries, aged 31–60 years old, and diagnosed as ADHF with various risk factors.The risk factor of ADHF for first patient was diabetes mellitus type 2, the secondpatient was dilated cardiomyopathy, the third patient was hypertension, and thefourth patient was aortic stenosis. Total energy requirement was 130–140% ofestimated basal energy requirement. Target of protein was 0.8–1.4 g/kg BW/day.Fat requirement was 25% of total energy with composition based on therapeuticlifestyle changes. Sodium intake was 2400 mg/day with fluid restriction averagedto 1500 mL/day. Micronutrient and specific nutrient supplementation such asvitamin B complex, C, B12, folic acid, zinc, and omega 3 were provided topatients based on clinical status. Result: There was improvement of clinical status and functional capacity in allpatients.Conclusion: An adequate nutritional management in ADHF patients based on risk factor and clinical status leads to better outcome and reduction of morbidity and mortality. ]