9.2.3.2.7 Low risk, Long, Nurse-led or pharmacist-led clinic Table 122: Clinical Evidence Summary: Agvall 2013: Long Nurse-led clinic (MDTcm) vs Primary care (1 control), >6 months for low-risk HFREF Outcomes No of Participants Quality of the evidence Relative effect Anticipated absolute effects Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: (studies) Follow up (GRADE) (95% CI) Risk with primary care Risk difference with MDTcm(95% CI) LOWa, b due to risk of bias, imprecision rate ratio 0.72 (from 334 fewer to 69 more) Point estimate suggests clinical benefit from MDTcm VERY LOWa, b due to risk of bias, imprecision (from 48 fewer to 120 more) Prescribed ACE-I or ARB LOWa, b due to risk of bias, imprecision (from 67 more to 260 more) Prescribed beta- blocker LOWa, b due to risk of bias, imprecision (from 163 fewer to 101 more) Renal function Serum creatinine at follow-up. Lower=better MODERATEa, b due to risk of bias The mean serum creatinine in the control groups was The mean renal function in the intervention groups was 1.90 umol/l lower (11.88 lower to 8.08 higher) (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. 