The outcomes extracted in the clinical review show moderate quality evidence of a clinical harm of the MDT for mortality, but moderate quality evidence of a clinical benefit from reduced hospitalisations, and low quality evidence of an improvement in quality of life. As mentioned above, the evidence on mortality was very imprecise and based on small numbers. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Overall the committee considered that overall the MDT may be cost saving and provide a clinical benefit; however, this is uncertain. No studies were identified that assessed the cost effectiveness of short term MDT intervention in high risk heart failure patients or any length MDT intervention in low risk heart failure patients. The committee agreed that the economic evidence suggests that an MDT reduces costs overall compared to usual care due to reduced hospitalisations, and noted that although each of the studies consisted of different competencies, the committee noted that a cardiologist and specialist nurse were included in all of the economic studies reviewed and therefore agreed that a physician with a subspecialty interest in heart failure, and a specialist heart failure nurse should be included in the core MDT. The committee discussed that the current composition of MDTs in clinical practice varies. The core professionals in most teams currently consist of a cardiologist and a specialist nurse as a minimum and in some cases can include many other professionals from other specialties. The committee therefore considered that the recommendation to have an MDT with a core team consisting of a physician with subspecialty interest in heart failure, a specialist heart failure nurse, competencies to manage prescribing, that could refer to other specialties if necessary, would not have an overall cost impact. 