(b) Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. Table 119: Clinical Evidence Summary: OPTIMAL (Mejhert 2004): Long Nurse-led clinic (MDTn) vs Primary care for high risk HF Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with primary care Risk difference with MDTn (95% CI) LOWa, b due to risk of bias, imprecision rate ratio (from 1000 fewer to 98 more) LOWa, b due to risk of bias, imprecision (from 55 fewer to 236 more) Quality of life Nottingham Health Profile Part 1, lower=better. Scale from: 0 to 600. LOWa due to risk of bias The mean quality of life in the control groups was The mean quality of life in the intervention groups was (21 lower to 39 higher) Prescribed ACE-I 208 VERY LOWa, b due to risk of bias, imprecision (from 183 fewer to 59 more) Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with primary care Risk difference with MDTn (95% CI) LOWa, b due to risk of bias, imprecision (from 180 fewer to 74 more) (a) Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias. (b) Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both. 