Knisel A, Elyasi M, Gibson G, et al. - Given the implication of inflammation in frailty seen in heart failure (HF), and association of macrophage migration inhibitory factor (MIF) with worse outcomes in HF and frailty as the key determining factor for advanced therapies (AT) eligibility, researchers here examined MIF levels in patients referred for advanced therapies (AT) and the changes in modified Fried Frailty Index (mFFI) and MIF after LVAD. In addition, subjective assessment (SA) was compared with mFFI testing in patients referred for AT. Assessment of 54 individuals (61±11 yrs) was done over 18 months; of these, 11 underwent LVAD. Frail patients were older, and exhibited lower albumin and Hb. Outcomes revealed significant underestimation of frailty in correlation with SA vs mFFI. Improvement was observed in both frailty scores and MIF after LVAD, indicating reversibility of the frailty syndrome. They suggest understanding frailty as significant for improving outcomes in advanced HF.