Some felt that that it was impossible for cardiologists to have the expertise and capacity to provide care for all the healthcare needs of patients with heart failure whose co-morbid conditions are complex, and therefore supported a focussed approach. Others felt that compartmentalisation of the clinical features into different distinct disorders does not help patients, and their own experience is that patients really value the attempt to provide an overview of all of their diagnoses and treatment. The subfinding on the decision to keep patients on the caseload was rated as low confidence due to concerns on relevance and adequacy of the data from only two papers. The committee felt that while it was important that decisions were made on an individual basis, the NICE guidelines should promote greater consistency and transparency in these decisions. Trade-off between benefits and harms The guideline committee appreciated the richness of the data in this qualitative review. They recognised that the nature of qualitative evidence offered an opportunity to identify recurring issues and examples of good practice. Continuity: The committee acknowledged that it is sometimes necessary for patients to move between different teams / services. For example, if a patient has been unwell, it is essential for the specialist HF service to follow- up and review their management and adjust any medication as necessary; but that once the patient is stable it is often appropriate to transfer routine care back to the GP. However, GPs and lay members had experience of patients receiving care by the specialist HF service without the involvement of their GP, to whom the patient was subsequently discharged. The committee agreed that an initial care plan should be developed by the HF MDT, and that this plan and subsequent contacts with the MDT should be communicated to primary care. 