ageing heart , stiff heart , heart not pumping efficiently ) or paradoxically even more complex terminology (e.g. left ventricular failure ). These alternative explanations often led to poorer communication, confusion for people with heart failure and lack of interest in their diagnosis as a consequence. People with heart failure were often unaware of the term heart failure . Many described that the term was not mentioned initially but introduced later on by specialists, often leading to shock and confusion for the patients. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Methodological limitations were rated moderate overall. Five studies were rated moderate limitations: two studies due to lack of context and role of the researcher, plus data analysis in one study and data richness in the other. Another two studies due to lack in data richness, plus missing information on the topic guide in one, and lack of reflection on the role of the researcher and loose link between findings and conclusions in the other. The fifth study due to no reflections on role of researcher and lack of detail on methodology. One study had serious limitations due to the secondary use of data and the subsequent inability to assess their methodology in detail, along with vague description of the analysis. Coherence was rated minor concerns overall. Agreement between papers was very good except one where healthcare professionals actually used the terminology heart failure with all their patients. Relevance was rated no or very minor concerns. The relevance of the subfinding to the focus of the review was very high. The data stemmed from three studies from the UK in a relevant population. Adequacy was rated as no concerns. 