This sub-finding was based on 2 studies 14, 294 . Methodological limitations were rated serious overall. Two papers were rated serious limitations the study of patient interviews because of the small number of participants (4), lack of clarity over methods, the researcher s voice is potentially prominent and lack of richness of data; the study of HCP interviews because of limited discussion and reflection on the role of the researcher and their methods. Coherence was rated no or very minor concerns overall. Agreement between papers was good, and while it does not directly align with the sub-finding concerning the primacy of primary care in providing continuity, it fits with the overall theme of this section regarding lack of continuity within the system as a whole. Relevance was rated minor concerns overall. The relevance of the sub-finding to the focus of the review was very high. Concern was due to one study being from outside the UK and the interviews being in Swedish. However the UK study of HCP shows that the issue is likely to extend to NHS services. Adequacy was rated as moderate concerns. The sub-finding was specific, and so sufficiently supported by lower numbers of studies. The issues are well described and explained, but overall the richness of the data falls short. The overall assessment of confidence was low, having been downgraded by 2 increments due to methodological limitations, and concerns over adequacy and relevance, while taking into account the support of the external literature. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Review sub-finding 2a: Poor co-ordination between services People with heart failure experience the healthcare system as being poorly co-ordinated. 