| Quality assessment | Summary of findings | Importance | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No of patients | Effect | Quality | ||||||||||
| No of studies | Design | Limitations | Inconsistency | Indirectness | Imprecision | Other | Specialized Multidiscip. Care |
Usual Care | Relative (95% CI) | Absolute | ||
| All Cause Mortality | ||||||||||||
| 8 | RCTs | no serious limitations |
no serious inconsistency |
serious | no serious imprecision |
none | 223/1453 (15.3%) |
259/1344 (19.3%) |
RR 0.71 (0.56 to 0.91) |
56 fewer per 1000 (from 17 fewer to 85 fewer) |
⊕⊕⊕Ο MODERATE |
CRITICAL |
| All Cause Mortality Direct Team Care | ||||||||||||
| 6 | RCTs | no serious limitations |
no serious inconsistency |
serious1 | no serious imprecision |
none | 94/617 (15.2%) |
126/511 (24.7%) | RR 0.60 (0.47 to 0.76) | 99 fewer per 1000 (from 59 fewer to 131 fewer) | ⊕⊕⊕Ο MODERATE |
CRITICAL |
| All Cause Mortality Indirect Team Care | ||||||||||||
| 2 | RCTs | no serious limitations |
no serious inconsistency |
serious2 | serious3 | none | 129/836 (15.4%) | 133/833 (16%) | RR 0.97 (0.77 to 1.21) | 5 fewer per 1000 (from 37 fewer to 34 more) | ⊕⊕ΟΟ LOW |
CRITICAL |
| All Cause Mortality SMCC vs. PCP | ||||||||||||
| 6 | RCTs | no serious limitations |
no serious inconsistency |
serious4 | no serious imprecision |
none | 95/575 (16.5%) |
114/464 (24.6%) |
RR 0.65 (0.51 to 0.84) |
86 fewer per 1000 (from 39 fewer to 120 fewer) | ⊕⊕⊕Ο MODERATE |
CRITICAL |
| All Cause mortality SMCC vs. Cardiologist | ||||||||||||
| 2 | RCTs | no serious limitations |
no serious inconsistency |
serious5 | serious6 | none | 128/878 (14.6%) |
145/880 (16.5%) |
RR 0.78 (0.46 to 1.32) |
36 fewer per 1000 (from 89 fewer to 53 more) | ⊕⊕ΟΟ LOW |
CRITICAL |
| HF-Specific Mortality | ||||||||||||
| 3 | RCTs | no serious limitations |
no serious inconsistency |
serious7 | no serious imprecision |
none | 195/892 (21.9%) |
258/892 (28.9%) |
RR 0.58 (0.32 to 1.05) |
121 fewer per 1000 (from 197 fewer to 14 more) | ⊕⊕⊕Ο MODERATE |
IMPORTANT |
| HF-Specific Mortality Direct Team Care | ||||||||||||
| 2 | RCTs | no serious limitations |
no serious inconsistency |
serious8 | serious9 | none | 12/132 (9.1%) |
30/134 (22.4%) |
RR 0.42 (0.21 to 0.83) |
130 fewer per 1000 (from 38 fewer to 177 fewer) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| HF-Specific Mortality Indirect Team Care | ||||||||||||
| 1 | RCTs | no serious limitations |
no serious inconsistency |
serious10 | serious11 | none | 183/760 (24.1%) |
228/758 (30.1%) |
RR 0.80 (0.68 to 0.95) |
60 fewer per 1000 (from 15 fewer to 96 fewer) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| HF-Specific Mortality SMCC vs. PCP | ||||||||||||
| 2 | RCTs | no serious limitations |
no serious inconsistency |
serious8 | serious9 | none | 12/132 (9.1%) |
30/134 (22.4%) |
RR 0.42 (0.21 to 0.83) |
130 fewer per 1000 (from 38 fewer to 177 fewer) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| HF-Specific Mortality SMCC vs. Cardiologist | ||||||||||||
| 1 | RCTs | no serious limitations | no serious inconsistency | serious10 | serious11 | none | 183/760 (24.1%) |
228/758 (30.1%) |
RR 0.80 (0.68 to 0.95) |
60 fewer per 1000 (from 15 fewer to 96 fewer) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| All Cause Hospitalization | ||||||||||||
| 7 | RCTS | no serious limitations |
serious12 | serious13 | no serious imprecision |
none | 527/1175 (44.9%) |
564/1222 (46.2%) |
RR 1.12 (0.92 to 1.35) |
55 more per 1000 (from 37 fewer to 162 more) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| All Cause Hospitalization Direct Team Care | ||||||||||||
| 5 | RCTs | no serious limitations |
serious14 | serious15 | no serious imprecision |
none | 194/287 (67.6%) |
193/335 (57.6%) |
RR 1.31 (0.94 to 1.82) |
179 more per 1000 (from 35 fewer to 472 more) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| All Cause Hospitalization Indirect Team Care | ||||||||||||
| 2 | RCTs | no serious limitations |
no serious inconsistency |
serious16 | no serious imprecision |
none | 311/836 (37.2%) |
351/833 (42.1%) |
RR 0.88 (0.79 to 0.99) |
51 fewer per 1000 (from 4 fewer to 88 fewer) | ⊕⊕⊕Ο MODERATE |
IMPORTANT |
| All Cause Hospitalization SMCC vs. PCP | ||||||||||||
| 6 | RCTs | no serious limitations |
serious17 | serious18 | no serious imprecision |
none | 266/415 (64.1%) |
268/464 (57.8%) |
RR 1.19 (0.94 to 1.49) |
110 more per 1000 (from 35 fewer to 283 more) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| All Cause Hospitalization SMCC vs. Cardiologist | ||||||||||||
| 1 | RCTs | no serious limitations |
no serious inconsistency |
serious10 | serious11 | none | 261/760 (34.3%) |
296/758 (39.1%) |
RR 0.88 (0.77 to 1) |
47 fewer per 1000 (from 90 fewer to 0 more) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| HF-Specific Hospitalization | ||||||||||||
| 6 | RCTs | no serious limitations |
serious19 | serious20 | no serious imprecision |
none | 216/1197 (18%) |
266/1185 (22.4%) |
RR 0.86 (0.62 to 1.19) | 31 fewer per 1000 (from 85 fewer to 43 more) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| HF-Specific Hospitalization Direct Team care | ||||||||||||
| 4 | RCTs | no serious limitations |
serious21 | serious20 | no serious imprecision |
none | 61/361 (16.9%) |
60/352 (17%) |
RR 1.07 (0.52 to 2.19) |
12 more per 1000 (from 82 fewer to 203 more) | ⊕⊕ΟΟ LOW |
IMPORTANT |
| HF-Specific Hospitalization Indirect Team Care | ||||||||||||
| 2 | RCTs | no serious limitations |
no serious inconsistency |
serious16 | no serious imprecision |
none | 156/836 (18.7%) |
206/833 (24.7%) |
RR 0.75 (0.62 to 0.9) |
62 fewer per 1000 (from 25 fewer to 94 fewer) | ⊕⊕⊕Ο MODERATE |
IMPORTANT |
| HF-Specific Hospitalization SMCC vs. PCP | ||||||||||||
| 4 | RCTs | no serious limitations |
no serious inconsistency22 |
serious23 | no serious imprecision |
none | 64/315 (20.3%) |
86/305 (28.2%) |
RR 0.73 (0.55 to 0.96) |
76 fewer per 1000 (from 11 fewer to 127 fewer) | ⊕⊕⊕Ο MODERATE |
IMPORTANT |
| HF-Specific Hospitalization SMCC vs. Cardiologist | ||||||||||||
| 2 | RCTs | no serious limitations |
serious24 | serious25 | serious26 | none | 152/882 (17.2%) |
180/880 (20.5%) |
RR 1.22 (0.43 to 3.45) |
45 more per 1000 (from 117 fewer to 501 more) | ⊕ΟΟΟ VERY LOW |
IMPORTANT |
1 study completed in New Zealand, 1 in Netherlands, 2 in Sweden, 1 in the United Kingdom and 1 study in Poland
1 study completed in Argentina and 1 study completed in the USA
Predominately one large study contributing to the estimate of effect
2 studies completed in Sweden, 1 in New Zealand, 1 in the United Kingdom, 1 in Poland and 1 in the USA
1 study completed in The Netherlands and 1 in Argentina
1 large study contributing 77% to the estimate of the effect
1 study from Argentina, 1 from Sweden, and one from Poland
1 study from Poland and one from Sweden
Sample size of both studies small
Study completed in Argentina
Only 1 study contributing to estimate of effect
Inconsistency in direction of effect, confidence intervals do not over lap, magnitude of effect ranges from RR of 0.90 to 2.01
Studies completed in New Zealand, USA, Argentina, 2 in Sweden, UK, and Poland
Studies vary in direction of effect and magnitude of effect ranges from a RR of 1.01 to 2.01, confidence intervals do not overlap
Studies completed in New Zealand, Sweden, UK and Poland
Studies completed in Argentina and USA
Estimates of effect vary in direction, size and confidence intervals do not overlap
Studies from New Zealand, USA, Sweden (2), UK and Poland
Studies vary in size and direction of effect. RR ranges from 0.52 to 2.18
Studies from The Netherlands, New Zealand, USA, Argentina, UK and Poland
Inconsistency in magnitude and direction of effect. RR ranges from 0.52 to 2.67
This evidence was not downgraded for inconsistency because there was only one small study contributing to 2.8% of effect size with a RR of 2.69, which is opposite in direction and magnitude of effect to the other 3 studies in the evidence profile.
Studies from Poland, UK, US and New Zealand
Magnitude and direction of studies differ, confidence intervals do not overlap
Studies completed in The Netherlands and Argentina
One large study contributing approximately 73% to the effect size