One paper was rated as minor limitations. Coherence was rated no or very minor concerns overall. Agreement between papers was good, although they revealed another instance of tension between the objectives of ease of access to specialists and continuity of care. Relevance was rated moderate concerns overall. The relevance of the sub-finding to the focus of the review was high. One patient interview study was not in the UK, and was originally in Swedish. The UK studies are both from before 2010, and the finding is likely to be sensitive to changes in service design. Adequacy was rated as moderate concerns. This sub-finding was adequately supported by a number of studies, but was lacking in depth. The overall assessment of confidence was low, having been downgraded by two increments due to combined concerns regarding methodology, relevance and adequacy. 5. The role of specialist HF services Review sub-finding 5a: Expectations The expectations of specialist HF services from people with CHF and primary care providers were seen to differ from what the service is delivering. What people providing HF specialist services think patients and primary care want is different again. For example: People with heart failure value the time the HF nurse has to spend with them, and the psychosocial support they provide; GPs however said they wanted HF nurses to be a resource for primary care, for advice and a point of contact with cardiology; but HF nurses felt a pressure from GPs to fill a gap in service provision. 