HF services can cause pt to lose touch with primary care and lose this continuity. Methodology minor limitations MODERATE Coherence minor concerns Relevance minor concerns Adequacy no or very minor concerns 1c Discharge from HF Clinic Interviews with pt Interviews with HCP People with heart failure and HF nurses both spoke of discharge from HF clinic as being a loss to the patient in terms of no longer being proactively followed up. Methodology serious limitations LOW Coherence no or very minor concerns Relevance minor concerns Adequacy moderate concerns Referral and approach to care Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Table 133: Summary of Co-ordination Study design and sample size Findings Quality assessment No of studies contributing to the finding Design Criteria Rating Overall assessment of confidence 2a Poor Co-ordination Between Services 2 x interviews of pt with advanced CHF and their care network with pt (inc. 1 with their carer) Secondary analysis of interviews of pt People with heart failure experience the healthcare system as being poorly co-ordinated, leading to increased burdens on them and to them being given conflicting advice. This in turn resulted in uncertainty and loss of confidence. Methodology moderate limitations MODERATE Coherence no or very minor concerns Relevance minor concerns Adequacy no or very minor concerns 2b Models to co-ordinate care 2 x interviews of mix of HCP 2 x interviews of HCP in HF services Interviews of pt and their care networks Health professionals were aware of several models that could be used to better co-ordinate care. Suggestions included: having a single professional to co-ordinate care; using heart failure nurses to facilitate cross-boundary working; and having conjoint working between primary and secondary care via means of a shared-care agreement . 