“…In the current study, informal pre-screening has already taken place, with the cardiologist already deciding not to screen for LVAD and HTx for obviously very vulnerable patients. In two recent studies of 60 and 99 patients on the HTx waiting list, 11 and 31 % of the patients appeared to be frail according to the Fried’s frailty criteria [46] , [51] . A direct comparison between the current study and other studies is limited by the fact that frailty is dynamic and heterogeneity exists with respect to heart failure severity, presence of an LVAD, INTERMACS profile, age etc.…”