The relevance of three studies was reduced as they were from outside the UK, two of the remaining studies are from before 2010, and the date of data collection from the final study is not reported. There could be concerns as to whether this is occurring in today s NHS context; however the breadth of the data, being from multiple countries, multiple settings, and multiple time points, increases its generalisability. Adequacy was rated as no or very minor concerns. The sub-finding was general and supported by numbers of studies. The sub-finding was descriptive and supported by the richness of data. The overall assessment of confidence was moderate, having been downgraded by 1 increment due to concerns over methodology and relevance. Review sub-finding 2b: Models to co-ordinate care Clinicians acknowledged that closer co-operation would improve patient care, and potentially reduce workloads. Different (non-mutually exclusive) suggestions came from within and across papers: Nominating a single professional to co-ordinate care. Heart failure nurses working in a cross-boundary role to encourage close working relationships. Co-working between primary and secondary care, possibly through means of a shared-care agreement . Such protocols were already in place for people who have other long-term conditions such as diabetes and hypertension, and enable general practitioners to manage patients in certain categories, with specialists managing patients presenting with more complexity. Protocols such as for shared-care were seen as having both pros and cons: they can improve transparency and facilitate co-working, but people with heart failure often also have other chronic problems and could end up being on multiple protocols, leading instead to confusion and increased burden of treatment Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Methodological limitations were rated serious overall. 