(c) 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. 9.2.3.1.6 High risk, Mid-length, MDT clinic Table 106: Clinical evidence summary: Ducharme 2005: Mid-length MDT clinic (MDTc) vs Primary / secondary 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/sec ondary Risk difference with MDTc (95% CI) LOW a, b due to risk of bias, imprecision rate ratio 314 fewer admissions per 1000 (from 88 fewer to 481 fewer) LOWa, b (from 112 fewer to 40 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/sec ondary Risk difference with MDTc (95% CI) 6 months due to risk of bias, imprecision 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 MIDs (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 1 MID or by 2 increments if the confidence interval crossed both MIDs. 