ISBN: Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with cardiology clinic Risk difference with MDTc (95% CI) Beta-blocker dose prescribed MODERATEa due to risk of bias The mean beta- blocker dose prescribed in the control groups was 13 mg The mean beta-blocker dose prescribed in the intervention groups was 21 mg higher (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 for indirectness as the outcome was not the protocol all-cause mortality. (c) Downgraded as not a protocol outcome for quality of life. Table 115: Clinical Evidence Summary: DEAL-HF (De la Porte 2007): Long MDT clinic (MDTc) vs Cardiology clinic for high risk HF Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with cardiology clinic Risk difference with MDTc (95% CI) Hospitalisation Days in hospital MODERATEa due to indirectness Rate Ratio 0.56 5279 per 1000 2310 fewer days in hospital per 1000 (from 1890 fewer to 2680 fewer)b MODERATEc due to imprecision (from 136 fewer to 6 more) (a) Downgraded due to indirectness as not protocol outcome for hospitalisation of count rates. (b) Manually calculated as GRADE cannot process RD above 1000. (c) Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 