PURPOSE: Little information exists on change in health-related quality of life (HRQOL) over time by left ventricular assist device (LVAD) implant strategy. The purpose of this study was to examine HRQOL by pre-operative implant strategy from pre-implant to 1 and 2 years after surgery. METHODS: Data were collected from mostly male, ≥ 50 years old, not working patients (pts) in the INTERMACS database who were stratified into 3 groups based on implant strategy: destination therapy (DT) (n=2901), bridge to transplant (BTT) (n=2209), and bridge to candidacy (BTC) (n=3076). HRQOL data were collected before and 1 and 2 years after surgery using the generic EQ-5D-3L visual analog scale (VAS) and heart failure-specific KCCQ-12 summary score (SS); higher scores=better HRQOL. General linear random effects models were used to examine whether HRQOL changed from pre-implant to 1 and 2 years post-implant by implant strategy. RESULTS: Regarding VAS modeling, a significant main effect of time (p<0.001) and a group by time interaction (p=0.01) were detected. No group differences emerged at baseline and year 1; at year 2, the BTT group had a higher VAS score than the BTC and DT groups (p<0.05). Regarding the group by time interaction, all groups improved significantly (p<0.001) from baseline to year 1 and baseline to year 2, while from year 1 to year 2, the BTT group improved (p=0.04) and the DT group declined (p<0.001). For the KCCQ-12 SS, a significant main effect of time (p<0.001) and a group by time interaction (p=0.04) emerged. At baseline, the BTT group had a higher KCCQ-12 SS than the DT and BTC groups (p<0.05) while there were no group differences at year 1 or year 2. Regarding the group by time interaction, all groups improved significantly (p<0.001) from baseline to year 1 and baseline to year 2. From year 1 to year 2, there was no significant change for the BTT group; the BTC and DT groups significantly declined (p= 0.04 and <0.01, respectively). Follow-up analyses stratified by age group (<50 vs. ≥50) showed that the group by time interactions for both measures were driven by the 50+ age group. CONCLUSION: Overall HRQOL improved across all 3 implant strategy groups from pre implant to 2 years post implant. Subtle declines emerged for DT pts from 1 to 2 years. These findings may assist clinicians with HRQOL-related interventions from before to mid-term after implant.