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BACKGROUND: Frailty is prevalent in patients with heart failure and is associated with adverse outcomes. However, the extent to which the Clinical Frailty Scale (CFS) accurately captures physical and cognitive decline and its prognostic utility in contemporary heart failure care remain uncertain.OBJECTIVES: In this study, the authors sought to examine how well the CFS reflects domains of physical and cognitive function and its association with 2-year all-cause mortality in hospitalized patients with heart failure, using data from the Japanese Registry of Acute Decompensated Heart Failure-Next (JROADHF-NEXT).METHODS: This study involved 3,905 patients from a prospective, nationwide, multicenter registry focusing on hospitalized patients with heart failure (JROADHF-NEXT). Patients were stratified into 6 categories (1-2, 3, 4, 5, 6, and 7-9) according to the CFS. Physical function was assessed using gait speed, the 5-chair stand test, the Short Physical Performance Battery (SPPB), grip strength, and 6-minute walk distance; cognitive function was measured using the Mini-Cog test. The primary outcome was 2-year all-cause mortality after discharge.RESULTS: Physical function metrics and Mini-Cog scores progressively worsened with increasing CFS severity. Over a 2-year follow-up, 725 patients (18.6%) died, with mortality increasing stepwise with higher CFS scores. Adding CFS to the prognostic model significantly improved discrimination compared with a model based on the SPPB and Mini-Cog test.CONCLUSIONS: The CFS is an independent predictor of 2-year mortality and a robust integrative measure of physical and cognitive vulnerability in patients with heart failure. The CFS provides a practical screening tool that complements formal performance-based frailty assessments in contemporary heart failure management.