What quality ratings were given to evidence regarding mortality, improvement in NYHA class and discontinuation and adverse events?
Mortality was rated as very low quality due to risk of bias, imprecision and inconsistency. The outcome improvement in NYHA class was also rated as very low quality due to risk of bias, indirectness (as this was interpreted as a surrogate for QoL as it implies an improvement in symptoms) and imprecision. The confidence intervals surrounding the effect estimate were wide which reduced the committee s ability to be confident in the results. Evidence regarding discontinuation and adverse events and serious adverse events were graded as low and very low quality, often due to risk of bias and imprecision.