Ansari 2003.
| Methods | Randomised controlled trial | |
| Participants | 74 health professionals recruited 169 patients diagnosed with heart failure that met the Framingham criteria and a LVEF ≤ 45% or moderate or severe left ventricular systolic dysfunction on their "latest evaluation" | |
| Interventions | Health professionals were randomised to 1 of 3 groups Group 1: Health professionals were provided with education on the initiation and up‐titration of beta‐adrenergic blocking agents Group 2: Nurse facilitator group: The study nurse practitioner, supervised by 2 cardiologists, was responsible for initiating, titration, and stabilising heart failure patients on beta‐adrenergic blocking agents. Once the patient reached maximum tolerated dose of beta‐adrenergic blocking agents, they were referred back to the primary care physician Group 3: Provider and patient notification: Health professionals were given a list of their patients who were potential candidates for beta‐adrenergic blocking agents. Computer alerts were activated when the provider accessed their patient's electronic medical record for the first 2 visits post‐randomisation. All patients in this group were mailed a letter about beta‐adrenergic blocking agents for them to discuss with their health professional at their next visit |
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| Outcomes | Primary outcome: Number of patients initiated, up‐titrated, and maintained on beta‐adrenergic blocking agents Secondary outcome: Proportion of patients reaching target doses of beta‐adrenergic blocking agents |
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A stratified randomisation using computer‐generated, random numbers" Comment: Randomisation occurred at the health professional level |
| Allocation concealment (selection bias) | Unclear risk | Comment: Allocation concealment was not reported |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Comment: All patients and health professionals were aware of the group allocation. There was no blinding |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "An independent research assistant assessed the use of beta‐blocker therapy" |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Comment: There was no report about incomplete outcome data |
| Selective reporting (reporting bias) | High risk | Comment: All outcomes except adverse events associated with the intervention were reported |