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. Healthcare professionals should consider discussing with the person their goals of ongoing treatment and whether the ICD remains in line with those goals, as part of general advanced care planning. This may be appropriate where the symptoms of a person with heart failure have deteriorated over a period of time despite optimal treatment, people whose care goals are changing, in very elderly people, and with people thought to be nearing the end of their life. The committee acknowledged that these reviews and conversations may be led by primary care services, for example, in circumstances where the person s heart failure is stable but they are of advanced age and general advanced care planning is applicable. Alternatively, they may take place in the specialist heart failure MDT if the person s heart failure is severe or the person is otherwise high risk and being managed by the specialist team. All health care professionals caring for patients with heart failure should be prepared and equipped to raise these issues with ICD recipients. The committee noted that specific issues were relevant where a person was thought to be entering their last days of life. The committee wished to emphasise the importance of health care professionals following the guidance in the Care of the dying adult guideline in these circumstances. The committee discussed the issues raised by the review around the logistical challenges of deactivation, many of which came from a UK based study. 