(c) Downgraded by 1 increment due to indirectness of the outcome (protocol outcome improvement in NYHA class; extracted outcome no. in NYHA class I). 6.3.1.3.2 Invasive strategy (angiography with intent to revascularise (with CABG or PCI) versus medical therapy Table 71: Clinical evidence summary: Invasive strategy + medical therapy versus medical therapy Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with medical therapy Risk difference with invasive strategy (95% CI) All-cause mortality 136 VERY LOWa,b due to risk of bias, imprecision (from 121 fewer to 224 more) Quality of life - EQ-5D Scale from: 0 to 1. VERY LOWa,b due to risk of bias, imprecision c The mean quality of life EQ-5D at 6 months in the intervention groups was (0.14 lower to 0.10 higher) Quality of life - MLWHF Scale from: 0 to 105. VERY LOWa,b due to risk of bias, imprecision c The mean quality of life - MLWHF at 6 months in the intervention groups was (11.35 lower to 3.55 higher) (a) Downgraded by 1 increment if majority of the evidence was rated high risk of bias, downgraded by 2 increments if majority of the evidence was rated very high risk of bias. (b) Downgraded by 1 increment if the confidence interval crossed one MID, downgraded by 2 increments if the confidence interval crossed both MIDs. (c) Unable to calculate as the study only reported the overall mean difference. Treating Heart Failure Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6.3.1.4 Economic evidence Published literature No relevant health economic studies were identified. 