Role of specialist heart failure services Within most findings there were sub-findings relating to (a) challenges/problems, (b) ideas for improvement, and (c) complex transition issues. The sub-findings are presented, along with an evaluation of the quality, including an explanation for the CerQual grading that appears with each sub-finding in the summary tables in 9.3.3.5. Relevancy was judged with respect to making recommendations on this particular issue for current NHS specialist and general services, taking into account that some evidence came from studies were conducted in other countries (studies from US and outside the OECD were excluded) and before major NHS configuration changes. Review sub-finding 1a: Lack of continuity in HF care Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Both people with heart failure and health professionals felt that heart failure care was fragmented, leading to a lack of continuity. This was contrasted in one study with the more seamless care offered to people with cancer. Patients who experienced lack of continuity found it made it more difficult to form therapeutic relationships, which undermined their confidence in their management plans. Patients aged 65 and under mentioned that lack of continuity sometimes led to encounters with professionals appearing anonymous and meaningless. This sub-finding was based on four studies 126, 144, 207, 225 . Methodological limitations were rated moderate concerns overall. Two papers were rated serious limitations as they were secondary analyses with insufficient information about the original interviews. One paper was rated as moderate limitations due to lack of context and data richness. One paper was rated as minor limitations. Coherence was rated no or very minor concerns overall. Agreement between papers was good and appeared to fit well with related findings in other studies. 