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Introduction: The prevalence, correlates and impact of the frail phenotype in acute decompensatedheart failure (ADHF) remain sparsely studied.Handgrip strength (HGS) is a validated and easily measurable parameter which may increase the feasibility of overall frailty evaluation in routine clinical assessment. Hypothesis: The discriminatory ability of weak HGS to identify hospitalized ADHF patients with more advanced disease and at increased risk of unfavorable hospitalization outcomes was investigated. Methods Patients with ADHF requiring in-hospital treatment with intravenous diuretic therapy were enrolled. Comprehensive clinical, laboratory and echocardiographic parameters were prospectively collected and HGS was measured within 24 hours of admission using a hand dynamometer (Jamar, Inc.). Patients performed a maximal isometric contraction with their dominant hand 3 times. Weak HGS was defined as a maximal value below the genderand body mass index-derived cut-offs provided by the Fried criteria. Unfavorable hospitalization outcome was defined as death, length of stay longer than the median, or discharge to a non-independent living setting. Results: 88 consecutive patients (mean age 64616yrs, 66% men, mean LVEF 32615%) completedHGSassessment.WeakHGSwaspresent in 70% (n562) of the population. Characteristics of patients with and without weak HGS are shown in Table 1. Following exclusion of those undergoing ventricular assist device implant pre-discharge (n56), 52% (n543) of the remaining patients experienced an unfavorable outcome. On multivariate logistic regression analysis, weak HGS (OR 6.9, 95% CI 1.3-37, p50.03) significantly predicted unfavorable hospitalization outcome, independent of other significant clinical variables (atrial fibrillation vs. sinus rhythm, lack of angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist therapy and lower admission systolic blood pressure). On likelihood ratio test, weak HGS provided incremental value to these parameters (final X2 23.1, p50.03) for prediction of short-term adverse outcome. Conclusions: Weak hand grip strength is a common finding in a tertiary referral ADHF population, and is associated with a greater burden of cardiovascular and renal disease, lower hemoglobin and worse nutritional parameters. Prospective admission assessment of this simple clinical measure provided independent and incremental value for prediction of unfavorable hospitalization outcomes. Grip strength may represent a useful, feasible marker of early risk in the ADHF population.