The committee discussed the issues raised by the review around the logistical challenges of deactivation, many of which came from a UK based study. While the committee felt that these challenges strongly resonated with their experiences of deactivation in the NHS context; commissioning, service delivery and service design issues are outside the scope of this guideline and so the committee was unable to make recommendations in this area. The committee emphasised the importance of any service that provides ICDs having services available to support the whole process from implantation to deactivation. Trade-off between net clinical effects and costs Economic studies were not sought for this review question. The committee considered that the recommendations made above represent best clinical practice and provide essential information to individuals to allow for shared decision making. If patients are well informed this could result in improved quality of life, due to a reduction in anxiety about the implantation, and potential future deactivation, not only for the patient but also their families and/or carers. Furthermore, informed decision making could reduce the number of painful unwanted shocks for individuals, again potentially providing some improvement in quality of life. The committee 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 acknowledged that there is likely to be a cost associated with providing written information for the patient and their family and/or carers. Some information on ICDs is already available from charitable organisations and some clinics already provide such information to their patients. Readily available information could be edited, or further supplementary information could be provided if not all aspects are covered from available materials. 