Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Table 116: Clinical Evidence Summary: Del Sindaco 2007:Long 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/s econdary care Risk difference with MDTc (95% CI) Hospitalisations - dichotomous 173 VERY LOWa, b, c due to risk of bias, indirectness, imprecision 187 fewer people admitted per 1000 (from 52 fewer to 299 fewer) VERY LOWa, c due to risk of bias, imprecision (from 138 fewer to 91 more) (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 for indirectness as not the protocol outcomes for hospitalisations, count rate. (c) Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. Table 117: Clinical Evidence Summary: PRICE (Atienza 2004): Long MDT clinic (MDTc) vs Cardiology for 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 MDTc (95% CI) MODERATEa due to imprecision rate ratio (from 183 fewer to 526 fewer) HIGH (from 36 more to 290 more) Quality of life 220 The mean quality of life in The mean quality of life in the Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 