Consideration of patient preferences is impor- tant for VA diagnosis and management deci- sions. Patient preferences for invasive therapies and acceptance of SCD risk vary and may evolve throughout the course of their illness. The writing committee endorses a shared decision-making approach as part of the general care for patients at risk for VA and SCD. A commonly accepted def- inition of the shared decision-makingS15-7 includes 4 components: 1) at least 2 participants, the cli- nician and patient, be involved; 2) both parties share information; 3) both parties take steps to build a consensus about the preferred treatment; and 4) an agreement is reached on the treatment to implement. Sharing a decision does not mean giving a patient a list of risks and benefits and telling them to make a decision a practice some authors have called abandonment. S15-8 Notably, a recommendation based on evidence or guide- lines alone is not shared decision-making. Rather, a recommendation based both on the evidence as well as an understanding of the patients health goals, preferences, and values is essential to achieving true shared decision-making. Also, the possibility of deactivation of an existing ICD should be discussed with patients who have ter- minal illnesses. 2. ICDs prolong lives as highlighted in many places within this guideline. However, a patient with HF or advanced noncardiac illness may elect to forgo replacement of an ICD when faced with the pros- pect of continual decline in health and functional status from either progressive HF or some other competing morbidity. Unfortunately, research suggests that patients are ill-informed when faced with understanding the risks, benefits, and downstream burdens of their ICDs. 