Abstract Body (Do not enter title and authors here): Background
Frailty is a known prognostic marker of adverse outcomes in adults with heart failure with preserved ejection fraction (HFpEF); however, there are over 60 frailty assessment tools and no standardized method to assess frailty in HFpEF.

Goals/Aims
This study aimed to conduct a head-to-head comparison of the prevalence and prognostic value of six commonly used frailty scales in adults with HFpEF.

Methods
We examined 203 ambulatory patients with HFpEF seen at Weill Cornell Medicine from June 2018 - August 2022. The following frailty scales were assessed: the Clinical Frailty Scale (CFS), the FRAIL scale (the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale), the 5-meter gait speed test, the five times sit-to-stand test (5-STS), hypoalbuminemia, and the modified body mass index (mBMI). Multivariable cox proportional-hazard models, adjusting for race and the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) prognostic risk score, were used to examine the association between frailty and the primary endpoint (a 1-year composite of all-cause mortality and all-cause hospitalization). A Bonferroni correction was included into our models.

Results
The median age was 76.7 years (IQR [69.7-83.9]), LVEF was 63.0 (IQR [59.0-68.0]), and MAGGIC score was 24.0 (IQR [19.0-28.0]). The prevalence of frailty ranged from 21.2% (hypoalbuminemia) to 77.8% (5-STS), and increased with advancing HFpEF severity on all frailty scales. In the adjusted analysis, the CFS, FRAIL scale and the 5-meter gait speed test were associated with the composite of all-cause mortality and all-cause hospitalization, Figure 1. A linear relationship was found between higher scores on the CFS, FRAIL scale, and the 5-meter gait speed test and the log-predicted odds of the composite of all-cause mortality and all-cause hospitalization.

Conclusion
The CFS, FRAIL scale, and the 5-meter gait speed test demonstrated associations with adverse outcomes among adults with HFpEF. These specific tools are quick to administer and easy to interpret, and thus may be appropriate for routine use in patients with HFpEF.