The committee noted that the trial upon which this evidence Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] was based, HEART,65 enrolled only 138 of the planned 800 patients and was thus underpowered. Other comparisons: There was no other evidence comparing PCI with medical therapy, or CABG plus ventricular reconstruction with medical therapy. Trade-off between clinical benefits and harms The committee discussed the evidence for an invasive strategy (angiography with intent to revascularise (with CABG or PCI)) versus medical therapy. The evidence on mortality suggested a possible clinical harm of an invasive strategy, but the committee was not confident in this evidence due to the very wide confidence intervals around the absolute risk difference (which range from clinically important benefit to clinically important harm) and the risk of bias. An invasive strategy appeared not to have a clinically important impact on quality of life, but again, the committee placed little weight on this evidence due to its very low quality. The committee discussed the evidence for CABG plus medical therapy, compared to medical therapy alone, and noted that CABG led to clinically important reductions in all-cause mortality and all-cause hospitalisations. The committee noted that this clinically important reduction in mortality was only evident at the extended follow-up period of 9.8 years, with 30 day mortality in patients receiving CABG being substantially higher than those receiving medical therapy alone (estimate of 24 more per 1000, ranging from 4 more to 70 more). 