For the reasons above, the committee was not convinced that CABG would demonstrate the same beneficial effect in the current UK ischaemic HFREF population, and any possible benefit could be outweighed by an increased risk of serious adverse events during or post-surgery. In light of their concerns about generalisability and applicability of the evidence on CABG to the general HFREF population, the committee decided that CABG should not be routinely offered to patients with HFREF. However, the committee recognised that a proportion of patients with ischemic HFREF may derive substantial benefit from CABG in the long term. In particular, people with more severe coronary artery disease and in whom viability has been established may be more likely to obtain a greater benefit from CABG than the average benefit demonstrated in the STICH(ES) trial although the sub-study looking for an influence of viability on the surgical outcome was unable to confirm this. For HFREF patients with extensive coronary disease, who have a surgical risk profile similar to the patients enrolled in the STICH(ES) trial, clinicians may wish to discuss the evidence on CABG as part of shared decision making regarding treatment options. That this is an area of significant uncertainty should be openly discussed with patients. In any shared-decision making with patients about CABG, a thorough discussion about the potential risks and benefits will be essential to enable informed consent. This discussion should go beyond the immediate post-surgery risks. In particular, clinicians should address any misconception that so long as a patient pulls through the surgery, their heart failure will necessarily be fixed , as some patients will have an excellent symptomatic response and others far less. 