Sanders NA, et al. - Researchers used a large contemporary clinical trial heart failure with preserved ejection fraction (HFpEF) cohort to describe frailty and understand how it influences patient outcomes. They created a frailty index (FI) at baseline with 39 clinical, laboratory, and self-reported variables, utilizing data from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. They selected a subset of 1,767 TOPCAT patients to examine the link between frailty and outcomes and the impact of frailty on the benefits of spironolactone. They found that frailty was seen often among TOPCAT HFpEF participants; defined as a FI > 0.21, frailty was evident in 94% of subjects. With increasing FI, parallel increases in body mass index, systolic blood pressure, and pulse pressure were observed. A higher risk of cardiovascular outcomes and mortality was observed in relation to greater frailty. No interaction was evident between frailty class and treatment effect of spironolactone.