The overall assessment of confidence was low, having been downgraded by 2 increments due to relevance concerns, and also for methodology and adequacy. Review sub-finding 4c: Access to Urgent Care Patients found that the HF clinic provided them easy access to physicians and nurses, and healthcare professionals noted that HF nurses were able to react more quickly to sudden changes in health status than cardiologists or GPs. This leads to a discrepancy in access between those who were active on the HF clinic caseload, and those discharged to primary care. It was clear that although access to specialists was valued, consistency of care was also needed, and the two were sometimes in tension. For example in one study, a specialist nurse explained: patients can ring us up at any time and we can see them on that day if we need to. There is no waiting around and ringing your GP , but GPs in that study felt patients needed a more holistic approach than the HF clinic offered because all they care about is the heart failure. pp300, 303 294 People with advanced heart failure and their carers reported uncertainty about where to seek help. One patient reported: I rang my GP who said to ring the hospital, rang hospital and was told they couldn t do anything, you have to ring GP! p120 8 This sub-finding was based on 3 studies225, 294#2771 . Methodological limitations were rated moderate overall. One paper was rated serious limitations due to lack of discussion and reflection. One paper was rated as moderate limitations due to lack of discussion and reflection on methods. One paper was rated as minor limitations. Coherence was rated no or very minor concerns overall. 