ISBN: 978-1-4731-3093-7 6.3.1.6 Recommendations and link to evidence Recommendations Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Relative values of different outcomes The committee considered the following outcomes to be critical for this review: all-cause mortality (over study duration), all-cause mortality (at 30 days), 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 such data take into account the broader unintended consequences of the interventions (for example, an increase in mortality or hospitalisations due to adverse events or surgical complications). Improvement in ejection fraction and NYHA class, as well as additional revascularisation events and stroke, were also considered to be important for decision-making. For the comparison of CABG versus medical therapy, there was evidence on all outcomes except for improvement in ejection fraction. For the comparison of an invasive strategy versus medical therapy, there was only evidence for all-cause mortality (over study duration) and quality of life. Quality of the clinical evidence CABG versus medical therapy: The evidence for the outcome of all-cause mortality over the duration of the study was graded low quality due to risk of bias (differential cross-over rates in the intervention and control groups) and imprecision (based on the wide confidence intervals around the relative effect). However, the committee noted that the sensitivity analysis performed by the study authors suggested that the high rate of cross-over might have underestimated the beneficial effect of CABG on mortality, and also noted that the confidence intervals around the absolute effect were reasonably narrow and showed a clinically important benefit. 