The data stemmed from three studies from the UK in a relevant population. Adequacy was rated as no concerns. The subfinding was explicitly supported by quite a few studies in much detail. The overall assessment of confidence was moderate, having been downgraded by one increment due to the concerns in methodology and coherence. 2. Understanding heart failure Review subfinding 2a: Understanding of diagnosis There is variability in the complexity and depth of patients understanding of their diagnosis. Most patients showed poor knowledge and misunderstanding of their condition and its implications, including treatments, their importance, side effects and limitations. Many did not connect symptoms they had to their heart failure; some even deduced their diagnosis from the medications they were taking. The lack of understanding was often compounded by confusion and short-term memory loss that is associated with heart failure. However, other patients showed a high level of interest in their illness, were proactive in seeking information (e.g. online), knew how to manage their condition, and were well informed and equipped for informed exchanges with healthcare professionals about heart failure. In one study the authors noted, however, that this was an unusual group of younger patients and/or those with a background in health. Healthcare professionals were sympathetic to patients uncertainty about the meaning of their diagnosis and about treatments, as they were aware that a lack of time for communication contributed to poor understanding. Methodological limitations were rated serious overall. Five studies were rated moderate limitations due to a mix of reasons including a lack of the role of researcher, data richness and details of methodology. Three studies were rated serious limitations; one study due to the secondary use of data and the subsequent inability to assess their methodology in detail, along with vague description of the analysis. 