 The purpose of this study is to compare health-related quality of life HRQOL outcomes in older 60-80 years advanced heart failure HF patients who undergo heart transplantation HT or mechanical circulatory support MCS as a permanent implant i.e., destination therapy DT and their caregivers. Our study will contribute to better patient-centered care of older advanced HF patients and their caregivers, by informing decision making and guiding strategies to enhance post-operative HRQOL. 