Healthcare professionals reported practical challenges in the deactivation of ICDs after a decision had been made. Issues were experienced out of hours and in the community or community hospitals where staff or magnets were not available. Lack of a clear process and understanding about how deactivation worked in the community, and organisational issues, were also reported as making the process long and difficult. Quality of the evidence The decsions around discussing deactivation was considered to be similiar in all populations and the committee agreed to include studies outsideof the UK. The confidence ratings for the different sub-findings in the review were 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 varied, ranging from moderate to very low. The committee weighed the confidence in the individual findings with their own experiences, and agreed that they were broadly consistent, despite much of the evidence being downgraded in confidence due to being conducted outside of the UK in settings that differed to varying degrees from the English NHS. Attitudes and understanding: 3 of the 4 sub-findings within this finding were rated very low confidence, with the fourth rated low confidence. All of the sub-findings were downgraded due to concerns about methodological limitations and relevance, with some also being downgraded for concerns about coherence and/or adequacy. Discussions: 2 of the 3 sub-findings within this finding were rated low confidence, with the third rated very low confidence. All were downgraded for relevance and adequacy, with one also downgraded for coherence. 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. 