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The Promoting Palliative Care for People With Heart Failure (The P3HF Study) 

P3HF is a pragmatic clinical trial via the electronic health record (EHR) that examines the impact of a clinical decision support tool to promote timely referral to palliative care for people hospitalized with heart failure. [HIC#2000038269]

Heart failure is a leading cause of morbidity and mortality, projected to affect more than eight million Americans by 2030 (1). Frequent symptoms, hospitalizations, and hospital readmissions are common, causing significant suffering, particularly near the end of life (EOL) (2-4). Conversations about prognosis, the benefits and harms of invasive treatments, and patients’ care goals and preferences are essential to promote goal-concordant care among this population. 

Clinical practice guidelines recommend palliative care as a Class I (strong) recommendation “for all patients with heart failure to improve quality of life and relieve suffering.

  1. Quinn KL, Shurrab M, Gitau K, et al. Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness: A Systematic Review and Meta-analysis. JAMA. 2020;324(14):1439-1450. 
  2.  Kavalieratos D, Corbelli J, Zhang D, al e. Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA. 2016;316:2104-2114. 
  3.  Mandawat A, Heidenreich PA, Mandawat A, Bhatt DL. Trends in Palliative Care Use in Veterans With Severe Heart Failure Using a Large National Cohort. JAMA Cardiol. 2016;1(5):617-619. 

  4. Robinson MR, Al-Kindi SG, Oliveira GH. Trends in Palliative Care Use in Elderly Men and Women With Severe Heart Failure in the United States. JAMA Cardiology. 2017;2(3):344-344.

    You can find more information about the trial at clinicaltrial.gov or contact the study team at pecillab@yale.edu.

Referral to Specialist Palliative Care (SPC) facilitates serious illness conversations and advance care planning, promotes referral to hospice, and reduces unwanted or unnecessary healthcare utilization among this population. However, less than 20% of people with heart failure receive this vital service.

We designed the P3HF clinical decision support tool through a five-step, theory-informed process involving interviews and focus groups with healthcare provider stakeholders at the Yale New Haven Health System. (https://pmc.ncbi.nlm.nih.gov/articles/PMC12870625/)

Patient risk is derived from a validated risk score tested on patients cared for tested at YNHH and is highly accurate and was tested in a prior clinical trial.

https://www.jacc.org/doi/10.1016/j.jchf.2021.03.006

https://jamanetwork.com/journals/jamacardiology/fullarticle/2795104

You can find more information about the trial at clinicaltrial.gov or contact the study team at pecillab@yale.edu.

Starting in April of 2026 we are conducting a randomized clinical trial to assess the feasibility and the preliminary efficacy of the P3HF CDS tool on clinician behavior change and patient outcomes.

We will randomize all eligible patients at two sites within the Yale New Haven Health system into the study. Every day the programed build will review the EMR and automatically examine the patient record. Those patients who meet inclusion criteria will be automatically enrolled in the study. We will purposefully enroll patients with a range of estimated 1- year prognoses who meet inclusion criteria.

Randomization occurs when a patient meets the initial inclusion criteria of:

  1. 18 years of age or older 
  2. BNP or NTPro-BNP >500 pg/ml 
  3. IV diuretics in the past 24 hours of admission 
  4. Not pregnant at time of admission

You can find more information about the trial at clinicaltrial.gov or contact the study team at pecillab@yale.edu.

Recommendation's 2

AHA Clinical Recommendations for Patients with Heart Failure

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