Professionals in HF services felt the decision about whether to keep a patient under follow-up in the HF clinic is complex and taken on an individual basis. Quality of the evidence The committee acknowledged the varied confidence ratings for the different subfindings in the review, some of which were fairly low. The members weighed the confidence in the individual findings with their own experience as patients and health professionals in the NHS, and agreed that the subfindings were broadly consistent with their own experiences. Continuity: The subfinding of lack of continuity was rated as moderate confidence, due mainly to methodology concerns. The subfinding of primary care as a key player in continuity was rated as moderate confidence due to minor concerns in coherence and relevance. The committee agreed with these subfindings, but also noted that general practitioners were less able to offer continuity than historically, due to different ways of working. The subfinding about discharge from HF clinic was rated as low confidence due to methodological concerns and being limited to two papers, but the committee felt that this subfinding agreed with their experiences. The lay Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 members explained how they built up a relationship with the HF clinic whilst they experienced significant health issues, and they felt vulnerable transitioning away from this to primary care. They were less sure about the major distinction being whether appointments were given or requested, and suggested the issue was more around the certainty of the hospital setting compared with uncertainty in, and continuity through, the GP setting. 