(b) 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. 9.2.3.2.1 High risk. Long, Nurse-led or pharmacist-led clinic Table 118: Clinical Evidence Summary: COACH basic (Jaarsma 2008): Long Nurse-led clinic (MDTn) vs Cardiology clinic in 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 MDTn (95% CI) MODERATEa due to risk of bias rate ratio 11 more per admissions 1000 (from 133 fewer to 189 more) LOWa, b due to risk of bias, (from 88 fewer to 43 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 cardiology clinic Risk difference with MDTn (95% CI) 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. 