Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 9.2.3.1.7 High risk, Mid-length, Nurse-led or pharmacist-led clinic Table 109: Clinical evidence summary: Driscoll 2014: Nurse-led clinic (MDTn) vs Primary / secondary care for high risk HFREF Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with primary/secondary Risk difference with MDTn (95% CI) Hospitalisations and Emergency department attendances VERY LOWa, b due to risk of bias, imprecision rate ratio 231 events per 1000 person years 76 fewer events admissions per 1000 person years (from 215 fewer to 1000 more) VERY LOWa, b due to risk of bias, imprecision peto OR c (from 120 fewer to 280 more)d Quality of life MLWHFQ (change score) lower=better. Scale from: 0 to 105. LOWa due to risk of bias The mean change MLWHFQ in the control groups was The mean quality of life in the intervention groups was 2.80 lower (better) (13.68 lower to 8.08 higher) Prescribed "optimal" dose beta-blocker 24 VERY LOWa, b due to risk of bias, imprecision (from 4 more to 1000 more) (a) 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 1 increment as confidence interval crossed 1 MID or 2 increments as confidence interval crossed both MIDs. (c) Cannot be estimated as no events in control arm. (d) Absolute difference calculated by RevMan. 