This was not explained by subgrouping the results by age, year of publication or the intensity of the intervention. Trade-off between clinical benefits and harms Overview of evidence The committee noted the likely publication bias in the evidence identified. The committee had requested inclusion of all studies in the review as it had thought it was likely that publication bias would be an issue in the evidence and that a more comprehensive search strategy not limited to larger studies would enable this to be more clearly identified. The committee was reassured that evidence was available from multiple larger studies for some interventions and endpoints but concerned that for other endpoints only data from one study was available with the most obvious deficiency being for quality of life data. The committee had reservations about the trial designs. The evidence as presented compared active interventions with usual care. One potential confounder was the effect of contact alone but without direct advice on changing management. This could result in a placebo effect that would be subsumed within the likely effects of intervention. Secondly, it was possible that trial results would also be dependent on the extent and adequacy of baseline management. An ideally managed population recruited to a trial might not show any benefit from additional intervention; conversely a population with lower quality management might show a large degree of benefit reflecting reversion to local guideline standards. The committee agreed that the lack of information regarding the usual care arm of the included studies reduced their ability to be confident that the effects observed in the intervention arm were not being overestimated by less than Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. 