Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

Fuentes-Abolafio, Iván José; Stubbs, Brendon; Pérez-Belmonte, Luis Miguel; Bernal-López, María Rosa; Gómez-Huelgas, Ricardo; Cuesta-Vargas, Antonio Ignacio

doi:10.1186/s12872-020-01725-5

Table 4 Summary of Findings and Quality of Evidence Assessment of Included Observational Longitudinal Cohort Studies (GRADE)

From: Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

Summary of findings					Quality of evidence assessment (GRADE)
Outcomes	N° studies	N° participants	Design^a	Risk of Bias^b	Inconsistency^c	Indirectness ^d	Imprecision^e	Other ^f	Level of Evidence	Importance
Six Minutes Walking Test (6-MWT)
All-Cause Mortality	18	15,033	Observational	NO	Consistency (+ 1)	NO	NO	NO	Moderate	Critical
All-Cause Hospitalisation	2	1374	Observational	NO	Not Serious	NO	NO	NO	Low	Critical
HF Mortality	6	1493	Observational	NO	Consistency (+ 1)	NO	NO	NO	Moderate	Critical
HF Hospitalisation	6	1851	Observational	Not Serious	Not Serious	NO	Not Serious	NO	Low	Critical
Hospitalisation and Mortality	11	4788	Observational	Serious (−1)	Consistency (+ 1)	Not Serious	NO	NO	Low	Critical
Short Physical Performance Battery (SPPB)
All-Cause Mortality	2	243	Observational	Very Serious (−2)	Serious (−1)	Not Serious	Serious (−1)	NO	Very Low	Critical
Hospitalisation and Mortality	3	231	Observational	Serious (−1)	Not Serious	Not Serious	Not Serious	NO	Very Low	Critical
Gait Speed
All-Cause Mortality	7	4828	Observational	NO	Not Serious	NO	Not Serious	NO	Low	Critical
All-Cause Hospitalisation	4	2002	Observational	NO	Not Serious	NO	Not Serious	NO	Low	Critical
HF Hospitalisation	2	719	Observational	NO	Not Serious	NO	Not Serious	NO	Low	Critical
Hospitalisation and Mortality	2	1146	Observational	NO	Not Serious	NO	Not Serious	NO	Low	Critical

In brief, the GRADE classification was carried out according to the presence, or not, of the following identified factors: (1) study design, (2) risk of bias, (3) inconsistency of results (4) indirectness (5) imprecision, and (6) other considerations (e.g. reporting bias). The quality of the evidence based on the GRADE criteria was classified as: (1) high (further research is unlikely to change our confidence in the estimate of effect and there are no known or suspected reporting bias); (2) moderate (further research is likely to have an important effect on our confidence in the estimate of effect and could change the estimate); (3) low (further research is likely to have an important effect on our confidence in the estimate of effect and is likely to change the estimate); or (4) very low (we are uncertain about the estimate) [38]
^a Design: Observational Longitudinal Cohort Studies show a Low Level of Evidence according to GRADE
^b Risk Of Bias: > 50% (NO) of the information is from studies with low risk of bias which rarely can affect the interpretation of results. 50% (Not Serious) of the information is from studies with moderate risk of bias which could affect the interpretation of results, and 50% of the information is from studies with low risk of bias. > 50% (Serious) or > 75% (Very Serious) of the information is from studies with high/moderate risk of bias which sufficiently can affect the interpretation of results
^c Inconsistency: > 50% (Consistency) presence of high degree of consistency in the results, such as effects in same directions and not variations in the degree to which the outcome is affected (large significant effects (Hazard Ratio or Odds Ratio > 2)). > 50% (Not Serious) presence of high degree of consistency in the results, such as effects in same directions although variations in the degree to which the outcome is affected (small significant effects or large significant effects). > 50% (Serious) or > 75% (Very serious) presence of high degree of inconsistency in the results, such as effects in opposite directions, or large variations in the degree to which the outcome is affected (eg, very large and very small effects or no significant effect)
^d Indirectness: > 50% (NO) of included studies report similar population (similar HF diagnosis and similar age), as well as the same functional test (although different distances or cut-off points) and the same outcome. > 50% (Not Serious) of included studies show different HF diagnosis but population with similar age, and the same functional test (although different distances or cut-off points) and the same outcome is reported
^e Imprecision: > 50% (NO) of included studies report a 95% CI, with a narrow range (it excludes 1.0), includes large effects in the same direction and the sample size is large. > 50% (Not Serious) of included studies report a 95% CI, with a narrow range (it excludes 1.0), includes large or small effects in the same direction and the sample size could be small. > 50% (Serious) or > 75% (Very Serious) of included studies present 95% CIs with wide range (it does not exclude 1.0) and includes small effects in both directions
^f Other: Publication Bias is not suspected, and > 75% of included studies included the outcome data in a multivariate models adjusted by variables which could change the effect (NO)

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ISSN: 1471-2261

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