Objective To investigate the clinical characteristics of acute decompensated heart failure in elderly inpatients and analyze the related clinical data in order to predict the factors influencing the short-term prognosis. Methods A total of 417 inpatients with acute decompensated heart failure admitted in our department from January to December of 2012 were enrolled in this study. There were 190 males and 227 females, with an age of (78.7±6.6)years, and 50.6% of them were over 80 years. Their clinical data, such as underlying diseases, complications, New York Heart Association (NYHA) classification, number of dysfunctioned organs, and serum level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected and retrospectively analyzed. Logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results The length of hospital stay of the cohort was (12.4±8.6)d. The patients having more than 2 dysfunction organs accounted for 86.8%. There were 74 cases died in hospital, with a mortality of 17.7%. The mortality was increased with the increased number of dysfunctioned organs (P＝0.001). Serum level of NT-proBNP before hospitalization and the highest level during hospitalization were significantly higher in the death group than in the survival group (P＝0.001). The patients (43.2%, 35/81) with their serum NT-proBNP level in an increased trend after hospitalization had significantly higher mortality than those (11.6%, 39/336) with the level decreased or in a stable status (P＝0.000). Logistic regression analysis indicated that the independent predictors of mortality were the number of dysfunctioned organs, respiratory failure, NYHA grade, change trend of NT-proBNP, the highest level of NT-proBNP during hospitalization, acute myocardial infarction, and hypoproteinemia in turn. Conclusion Acute congestive heart failure in elderly patients is characterized with complicated causes, severe status, and is commonly associated with multiple organ dysfunction and poor prognosis. It is essential to diagnose the disease quickly and protect the organs function as early as possible.