Decision making: the sub-finding that patients felt that healthcare professionals should decide about deactivation was rated moderate confidence, with the only downgrade being for relevance. The second sub- finding that healthcare professionals felt that patients should decide about deactivation was rated very low confidence due to concerns about methodological limitations, relevance and adequacy. Trade-off between benefits and harms The committee agreed that the findings and sub-findings identified in the review resonated with their own experiences as healthcare professionals or lay members connected to heart failure services in the NHS. The committee acknowledged that some of the sub-findings identified in the review reflect general issues around communication and information needs in health care and are addressed by recommendations in the patient experience guideline CG138. The committee decided to focus on the issues raised that are specific to the deactivation of ICDs in heart failure. The committee discussed the review finding about discussing ICD deactivation. The committee agreed that deactivation should be explained and discussed pre-implantation. Although some patients may not want this information at the time of implantation, it is a necessary part of shared decision making and informed consent process. 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. 