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Introduction: Measures of frailty are predictive of morbidity and mortality in patients with left ventricular assist device (LVAD) placement. While Fried’s Frailty Assessment (FFA) is well-validated, sarcopenia has emerged as a powerful predictor. The additive value of sarcopenia to existing frailty assessments and its association with outcomes in patients undergoing LVAD implantation is not well-characterized. Hypothesis: We assessed the hypothesis that sarcopenia in addition to FFA improves the assessment of frailty and that patients identified as frail may experience worse outcomes after LVAD implantation. Methods: We evaluated 34 patients who underwent LVAD implantation at our medical center between January 2018 and December 2020. Perioperative FFA score ≥ 3 was defined as frail. Skeletal muscle indices were measured using perioperative computed tomography imaging of the psoas and pectoralis major and minor muscles areas. Sarcopenia was defined per the lowest skeletal muscle tertile with total psoas area index ≤4.45 and pectoralis muscle index ≤4.50. Results: Of the 34 patients who had LVAD placement, 12 received HeartWare HVAD and 22 received HeartMate III. Five patients met criteria for frailty based on FFA. When combined with frailty based on sarcopenia, 13 additional patients met criteria. There were no differences in age (57 vs 54.5 years, p = 0.49) or gender (89% vs 100% male, p = 0.62) between the frail and non-frail groups. On Kaplan-Meier analysis, the frail group had significantly higher rates of composite outcome of 30-day readmission and all-cause mortality (log-rank p = 0.027), (Figure 1). There was no difference in rates of transplantation. Conclusions: In conclusion, FFA is a commonly used tool for assessing frailty in patients with heart failure. The addition of sarcopenia assessment allows for higher sensitivity in identifying patients with frailty who are at risk for poor outcomes. Larger studies are needed to validate these findings.