Nurse‐led titration versus usual care for people with heart failure with reduced ejection fraction

Patient or population: people with heart failure with reduced ejection fraction
Settings: outpatient clinic, primary care clinic, residential care facility, telephone follow‐up
Intervention: Nurse‐led titration versus usual care

All‐cause hospital admissions
Follow‐up: median 12 months

RR 0.80
(0.72 to 0.88)

560
(4 studies)

⊕⊕⊕⊕
high

Heart failure‐related hospital admissions
Follow‐up: median 12 months

RR 0.51
(0.36 to 0.72)

642
(4 studies)

⊕⊕⊕⊝
moderate³

All‐cause mortality
Follow‐up: median 12 months

RR 0.66
(0.48 to 0.92)

902
(6 studies)

⊕⊕⊕⊝
moderate^2,3

All‐cause event‐free survival
Follow‐up: median 12 months

RR 0.60
(0.46 to 0.77)

370
(3 studies)

⊕⊕⊕⊝
moderate³

Proportion reaching target dose of medications
Follow‐up: median 12 months

RR 1.99
(1.61 to 2.47)

966
(5 studies)

⊕⊕⊝⊝
low^1,2,3

*The assumed risk is based on the observed incidence across the pooled control groups. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.