Subject to Notice of rights. ISBN: 978-1-4731-3093-7 and indirectness of the reported outcomes. All-cause mortality (n=3445) was rated as moderate quality with the confidence interval ranging from a decrease and increase in all-cause mortality hHigh quality evidence was found for all-cause hospitalisation (count rate) (n=3445), and showed a clinically important reduction with MRAs (associated with wide confidence intervals around the effect estimate). Moderate quality evidence was found for the outcomes QoL as measured by the MLWHF (n=400) and SF-36 physical functioning component (n=400), all-cause hospitalisation (dichotomous) (n=408), hyperkalaemia (n=3845) and worsening renal function (n=3845). For both the moderate quality QoL outcomes there was no clinical effect of MRAs. For the remaining moderate quality outcomes there was a clinically important increase in hospitalisations (associated with wide confidence intervals around the effect estimate), hyperkalaemia and worsening renal function with MRAs. The remaining outcomes were all rated as low or very low quality. These included all-cause mortality (dichotomous), QoL as measured by the KCCQ and EQ5D-VAS, number of participants with NYHA class I status and gynaecomastia. All of these outcomes showed no clinical effect of MRAs. Economic No relevant economic evaluations were identified. 6.2.3.6 Recommendations and link to evidence Research recommendation No recommendation Relative values of different outcomes The committee considered the following outcomes to be critical for this review: all-cause mortality, quality of life, and all-cause hospitalisation. Data on all-cause mortality and hospitalisation were considered preferable to data limited to heart-failure related mortality and hospitalisations, as all-cause takes into account the broader unintended consequences of the interventions (for example, an increase in mortality or hospitalisations due to adverse events). Improvement of NYHA class and specified adverse events (hyperkalaemia, renal function, hypotension, and gynaecomastia) were also considered to be important for decision-making. Evidence was identified for all outcomes except for hypotension. 