It was not felt to be worthwhile to prioritise research that aimed to add to or improve on these at the current time. Trade-off between clinical benefits and harms There was substantial heterogeneity in the study designs, patient populations, types of intervention and lengths of follow-up, and the evidence was of poor quality for many of the outcomes. Because of this, the committee generally found it challenging to identify which MDT interventions and team compositions were likely to be of the greatest benefit, and for whom. In patients in the high risk categories identified in the last guideline, there was some evidence that the involvement of the MDT may lead to the prescription of more appropriate medication, decrease number of hospitalisations and improve quality of life. It was discussed that in high risk patients, while most interventions did decrease hospitalisations, there were increased deaths in some of these studies. The possibility was raised that the avoidance of hospitalisation could have increased the risk of mortality, but as the evidence on mortality was very imprecise and based on small numbers, it was felt this was likely to be a chance finding. There seemed to be evidence of a general effect of extra hours of contact being associated with improved outcomes in high risk patients, with some Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 caveats. First, there seems to be a ceiling effect: although some shorter interventions delivered improvement, extended follow-up (over years) in a clinic offered little benefit; and delivering 40 hours of contact gave only the same benefit of 20 hours of contact. 