Table 124Clinical Evidence Summary: HICMann (Peters-Klimm 2010): Non-specialist case management (MDTcm) vs Primary care (1 control) >6 months for HFREF

OutcomesNo of Participant s (studies) Follow upQuality of the evidence (GRADE)Relative effect (95% CI)Anticipated absolute effects
Risk with primary careRisk difference with MDTcm (95% CI)
Hospitalisations178
(1 study)
12 months		⊕⊖⊖⊖
VERY LOWa,b
due to risk of bias, imprecision		rate ratio 1.23
(0.78 to 1.94)		374 per 100086 more admissions per 1000
(from 82 fewer to 351 more)
Death190
(1 study)
12 months		⊕⊖⊖⊖
VERY LOWa,b
due to risk of bias, imprecision		RR 1.07
(0.32 to 3.56)		51 per 10004 more per 1000
(from 35 fewer to 131 more)
Quality of life
Kansas City Cardiomyopathy Questionnaire, final score. higher=better. Scale from: 0 to 100.		180
(1 study)
12 months		⊕⊖⊖⊖
VERY LOWa,b
due to risk of bias, imprecision		The KCCQ final score in the control groups was
66.3		The mean KCCQ in the intervention groups was
1.70 higher (better)
(3.28 lower to 6.68 higher)
Quality of life (physical)
SF-36 physical health composite, final score. higher=better. Scale from: 0 to 100.		131
(1 study)
12 months		⊕⊕⊖⊖
LOWa
due to risk of bias		The mean SF-physical in the control groups was
38.3		The mean SF-physical in the intervention groups was
0.3 lower (worse)
(3.25 lower to 2.65 higher)
Quality of life (mental)
SF-36 mental health composite, final score. higher=better. Scale from: 0 to 100.		131
(1 study)
12 months		⊕⊕⊖⊖
LOWa
due to risk of bias		The mean SF-mental in the control groups was
46.6		The mean SF-mental in the intervention groups was
0.1 lower (worse)
(3.5 lower to 3.5 higher)
Prescribed double therapy of ACE-I/ARB and B-blocker180
(1 study)
12 months		⊕⊕⊖⊖
LOWa
due to risk of bias		RR 1.01
(0.84 to 1.2)		720 ACE+BB per 10007 more ACE+BB per 1000
(from 115 fewer to 144 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 by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.

From: 9, Referral and approach to care

Cover of Chronic Heart Failure in Adults
Chronic Heart Failure in Adults: Diagnosis and Management.
NICE Guideline, No. 106.
National Guideline Centre (UK).
Copyright © NICE 2018.

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