The committee agreed to make a recommendation to emphasise the importance of deactivation being discussed at this stage, and outlined some of the key issues that should be covered in that discussion, including: the risks, benefits and consequences of implantation, the process of deactivation and the circumstances in which deactivation may be appropriate, including the potential harms of not deactivating, the possibility of partial deactivation of the ICD without deactivating the Cardiac Resynchronisation Therapy component (in the patients with CRT-D devices) the possibility of reactivation if the person s condition changes or improves common misconceptions about the function of an ICD and the consequences of deactivation. In line with the review findings, the committee agreed that the discussion should be followed up with written information so the person and their Chronic Heart Failure Advanced heart failure and palliative care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 family had time to digest the information and make an informed decision. The committee noted in the review findings that discussions about deactivation occurring at the time of implantation were often forgotten by the time they became relevant, that discussions were avoided by all parties, and that they were often held too late, causing delays in deactivation and potential unnecessary harm. The committee agreed that the possibility of deactivation should be revisited regularly by healthcare professionals caring for that person. The committee decided that the appropriateness of continuing the ICD should be considered by the person s health care team at each 6 monthly review of their heart failure. This did not mean that a conversation had to take place with the patient about deactivation at each 6 monthly review, but it was important that the healthcare professional considered it. 