It is not clear to what extent the same problems occur in the NHS, but given the similarly pattern of HF clinic discharge, there is potential for the same issue to arise. Adequacy was rated as serious concerns; it was limited by the number of participants and lack of depth. The overall assessment of confidence was very low. The overlap between the rating of methodology and adequacy rating was taken into account when downgrading, but it was still felt necessary to downgrade by three increments due to the serious concerns raised. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 4. Contact / Access Review sub-finding 4a: Access to Routine Care People with heart failure who were not receiving specialist treatment reported that it was challenging to access specialist advice or secondary care, and that they have to spend time trying to access these through their general practitioner. Once receiving specialist care, or after discharge, patients reported that continued access to the support they felt they needed was also not straight- forward. Some patients felt that the illness itself made asking for help harder. One patient reports If you have a heart issue you have to shout and speak for yourself and keep at somebody And if you re not feeling well that s not what you want to be doing .207 p 108 This is contrasted with patients who have cancer, who found their condition was a door-opener , so they did not have to assert their needs in the same way. 