The overall assessment of confidence was low, having been downgraded by two increments due to concerns regarding methodology, and adequacy along with other minor concerns. Review sub-finding 3a: There is poor communication between services People with heart failure, their informal carers and professionals within and outside HF services all felt that there was poor communication across boundaries, especially between hospital-based services and primary / community care. Inadequate and delayed transfer of information led to burden on patients and waste of resources. In some areas it contributed to lack of / under- treatment, where management plans were not shared with the prescriber. One patient explained how this happened: there were times when there was a bit of a lack of communication, you know. I would go speak to my doctor [GP] and tell him I m on such and such, and he would say I ve not had any word about that . And that s part of the problem; you get a printed prescription that has, for instance, if I was on 4.5mg of Bisoprolol and they [hospital] were putting it up to 7.5, often the liaison between the hospital and the doctors wasn t all that good Methodological limitations were rated serious overall. Three papers were rated serious limitations, including two secondary analyses and one with limited detail and reflection. Three papers were rated moderate limitations, two due to lack of richness and context, and a third due to poorly defined aims and method. Coherence was rated no or very minor concerns overall. Agreement between papers was good, and is supported by many of the other studies in an implicit way. Relevance was rated no or very minor concerns overall. 