Quality of the clinical evidence Twenty two studies (23 comparisons) were identified. The studies were stratified into 2 categories of heart failure risk (high risk and low risk) and 3 lengths of intervention duration (3 months or less, between 3 and 6 months and over 6 months). The population risk (high versus low) was based on the existing recommendations for people who may benefit more from an MDT. The included those with a new diagnosis; requiring medication titration and/or surgical procedure; recent deterioration and severe and/or unresponsive disease. In the current review 14 of the 17 studies in the high risk category selected patients on the basis of recent deterioration, with only 1 selecting new patients, 1 specifically targeting patients requiring medication titration, and 1 selecting on the basis of severe HF with a need for palliation. Population risk in the studies was also described by the average number of all-cause hospital admissions per person per year in the control arms, where this could be calculated. There were only 3 studies that were 3 months or less; and all studies included in the low risk category were over 6 months long. The studies had a heterogeneous mix of populations, interventions and standards of usual care. The studies also ranged in scale from 25 participants followed for 6 months to 920 participants followed for an average of 4 years. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Due to the heterogeneity, meta-analysis of the studies was not considered appropriate. The quality was variable, with the main reasons for downgrading due to risk of bias being a lack of detail about randomisation/allocation concealment and imprecision due to small study size. 