HCP from HF services felt that they did not have the ability to assess and treat some comorbidities (an example condition was iron-deficiency anaemia). They also felt that addressing people s primary care issues could: take patients out of contact with primary care, potentially causing a loss of continuity; and leave HF services without capacity to manage HF care across their caseload. This sub-finding was based on 2 studies127, 325 . Methodological limitations were rated moderate overall. One paper was rated serious limitations due to lack of information on methods and data analysis, and not all findings being supported by data. One paper was rated as minor limitations. Coherence was rated no or very minor concerns overall. Agreement between papers was good. The sub-finding was compatible with other sub-findings in the review. Relevance was rated moderate concerns overall. The relevance of this sub-finding to the focus of the review was somewhat indirect. There was also some concern due to both studies being from outside the UK. Adequacy was rated as moderate concerns. The sub-finding was specific and supported by a number of studies, but is more than just descriptive, so would benefit from a greater richness of data. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 The overall assessment of confidence was low, having been downgraded by two increments due to adequacy foremost, and also methodology and relevance. Review sub-finding 5c: Decision to keep patients on the caseload One study looked at care networks of patients with advanced heart failure. 