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. One consequence of poor co-ordination was increased treatment burdens, as they needed to attend hospital/clinics on multiple occasions. They also experienced being given conflicting advice, for example by the cardiologist and nephrologist, leading to uncertainty and loss of confidence. People with heart failure also found the organisation of the healthcare system unclear and confusing. Individuals recalled the difficulties they had experienced trying to get referrals to rehabilitation services and nursing services that they needed. They suggested a clearer organisational process where they could identify who had responsibility, and where things like rehabilitation were offered automatically Methodological limitations were rated moderate overall. Two papers were rated serious limitations: a secondary analysis which did not give enough detail about data collection or context, and an interview study due to a combination of lack of researcher reflection and inadequate richness. Two papers were rated as moderate limitations due to a lack of researcher reflection, inadequate richness and lack of discussion. Two papers were rated as minor limitations. Coherence was rated no or very minor concerns overall. The sub-finding of poor co-ordination is present throughout these six studies, and is implicit in other studies. All positive experiences encountered in this review were of individual teams, and most negative experiences in the studies are between settings although many of these were between inpatient hospital and community, which is outside the scope of this review. Relevance was rated minor concerns overall. 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. 