Patients undergoing durable mechanical circulatory support (MCS) are increasingly elderly patients 70 years of age and older who are not transplant candidates and undergoing destination therapy for advanced heart failure (AHF). Several studies have demonstrated that carefully selected older patients for MCS have similar clinical outcomes as their younger counterparts. Frailty is a physiologic state involving multiple organs, with decreased resistance to stressors that increase in prevalence with age. Frailty is a marker for increased risk of adverse events and mortality across many disease states, and recent studies have shown that in addition to aging, frailty, and malnutrition can significantly increase the risk of poor outcomes after an MCS implant. Although there is no consensus on the method of measuring frailty, common frailty measurements used in AHF are the Fried phenotype score and the Rockwood Frailty Index. Nutritional evaluation has yet to be extensively studied in AHF. There is a consensus that malnutrition can adversely affect outcomes after MCS and few retrospective studies have used malnutrition assays to predict outcomes in patients before MCS implant.