Objective To investigate the pathogen distribution in and risk factors for community-acquired pneumonia (CAP) in the elderly patients with heart failure (HF). Methods Sixty elderly patients with HF admitted to Hefei Women and Child Healthcare Hospital from January 2015 to May 2016 were included as study group, and the control group were forty-three patients with HF wor-sened by non-infectious factors admitted to the hospital during the same period. The clinical data and SF-36 health survey scale scores were collected for all patients. Sputum samples were collected and culture-based diagnosis and drug-resistance testing were performed. Statistical analysis was performed using SPSS statistics 23.0, t-test or χ² test was used for the comparison between groups according to the data type. Logistic regression analysis was conducted to explore the risk factors for CAP. Results In 60 patients with CAP, 71 strains of pathogens were isolated, of which 43(60.6%) were Gram-negative bacteria, 21(29.6%) Gram-positive bacteria, and 7(9.9%) fungi. The main Gram-negative bacteria had high rates of resistance to quinolones and third-generation cephalosporins but were sensitive to imipenem. Gram-positive bacteria were generally resistant to penicillin and clindamycin but sensitive to vancomycin. Logistic regression analysis showed that both smoking (OR 2.91, 95%CI 1.13-7.44; P=0.026) and poor quality of life at baseline (OR=0.98, 95%CI 0.97-0.99; P<0.001) were the risk factors for CAP (P<0.05). Conclusion CAP in elderly patients with HF was mainly caused by Gram-negative bacteria, which are resistant to cephalosporins and quinolones. Smoking and poor quality of life at baseline are risk factors for CAP in the elderly patients with HF.