Objective To evaluate the efficacy and safety of bilevel positive airway pressure (BiPAP) ventilation as adjuvant therapy in the aged patients with acute exacerbation of chronic heart failure. Methods A total of 40 aged patients with acute exacerbation of chronic heart failure admitted in our department from July 2011 to December 2012 were enrolled in this study. There were 22 males and 18 females, with the age of (79.0±5.5)years. Their respiratory rate, blood pressure, heart rate, pulse oxygen saturation, arterial blood gas analysis, serum level of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and the class of New York Heart Association (NYHA) before and after BiPAP ventilation were recorded and compared. The rates of endotracheal intubation and complications after BiPAP ventilation were analyzed. Results After BiPAP ventilation, arterial partial pressure of oxygen, and arterial oxygen saturation were elevated compared with those before treatment (P＜0.001), but, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, NYHA class, and serum level of NT-pro-BNP were reduced (P＜0.01). Of all patients, 38 cases were effective to BiPAP ventilation, and 2 cases required endotracheal intubation. Two patients died in hospital. No breathing machine-related pneumonia, severe arrhythmia, or newly occurred myocardial infarction was found. Conclusion BiPAP, as an adjuvant therapy, improves the clinical symptoms in the elderly patients with acute exacerbation of heart failure, and promotes the heart and lung function rapidly and safely.