Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Drs. Kensuke Ueno (The University of Tokyo), Kentaro Kamiya (Kitasato University), and Tetsuya Takahashi (Juntendo University) to discuss the role of frailty in shaping cardiovascular versus noncardiovascular mortality across left ventricular ejection fraction (LVEF) subtypes. They provide expert commentary on the recent JACC: Heart Failure publication (Frailty Phenotype and Cardiovascular vs Noncardiovascular Mortality: Differences Across Left Ventricular Ejection Fraction Subtypes, Ueno K, Kamiya K, et al., 2025; doi:10.1016/j.jchf.2025.102654), which analyzed 5,777 patients aged ≥65 years from the nationwide J-Proof HF registry. The study found frailty prevalence exceeded 60% across all LVEF groups, but its prognostic significance diverged—frailty was linked to cardiovascular mortality in HFrEF, and to noncardiovascular mortality in HFpEF. These findings highlight how frailty cuts across heart failure phenotypes yet carries distinct risks, underscoring the need for tailored management strategies in older adults with HF.

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