[2018] See NICE s technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. 87.When discussing implantation of a cardioverter defibrillator: explain the risks, benefits and consequences of cardioverter defibrillator implantation, following the principles on shared decision making in the NICE guideline on patient experience in adult NHS services ensure the person knows that the defibrillator can be deactivated without affecting any cardiac resynchronisation or pacing, and reactivated later explain the circumstances in which deactivation might be offered discuss and dispel common misconceptions about the function of the device and the consequences of deactivation provide the person and, if they wish, their family or carers with written information covering the information discussed. [2018] 88.Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: at each 6-monthly review of their heart failure care whenever their care goals change as part of advance care planning if it is thought they are nearing the end of life. [2018] 89.Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 90.If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure MDT and consider a needs assessment for palliative care. [2018] 91.People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] Chronic Heart Failure Reference list NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 11 Reference list 1. Abhayaratna WP, Marwick TH, Becker NG, Jeffery IM, McGill DA, Smith WT. Population- based detection of systolic and diastolic dysfunction with amino-terminal pro-B-type natriuretic peptide. American Heart Journal. 