Objective To investigate the values of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) in severity assessment and prognostic prediction in the elderly patients with chronic heart failure. Methods A total of 122 elderly patients with chronic heart failure admitted in our hospital from January 2013 to June 2015 were enrolled into the study. According to New York Heart Association (NYHA) classification, the patients were divided into 3 group, that is, NYHAⅡ group (n=30), NYHAⅢ group (n=36), and NYHAⅣ group (n=56). Another 50 healthy individuals served as normal controls. The patients of NYHAⅣ group were further assigned into death subgroup (n=14) and non-death subgroup (n=42). The relationship of serum NT-proBNP level with left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDd) was analyzed. The change of NT-proBNP level was compared among the 3 groups before and in 7 and 14 d after treatment. The serum level of NT-proBNP was monitored during the follow-up of 6 to 12 months. Results With the increase of NYHA classification, the age, LVEDd and NT-proBNP level were increased, while LVEF was decreased in the subjects. Serum NT-proBNP level was positively correlated with LVEDd (r=0.96, P<0.05) and negatively correlated with LVEF (r=-0.79, P<0.05). The level of NT-proBNP was significantly decreased in the patients from the 3 groups in 7 d after treatment (P<0.05), and further reduced after 14 days’ treatment, but significant difference was only found in NYHAⅢ group and NYHAⅣ non-death subgroup between the levels of 2 time points (P<0.05). Compared with the non-death subgroup, the level was remarkably higher in the death subgroup before, in 7 d after treatment and at the last time of detection (P<0.05). In the non-death subgroup, the level was in a trend of reducing (P<0.05). But in the death subgroup, there was no statistical difference in the level before and in 7 d after treatment (P>0.05), and the level was also higher at the last time of detection (P<0.05). Conclusion NT-proBNP is closely associated with heart function, and can be regarded as an important indicator in the diagnosis, efficacy evaluation and prognostic prediction for heart failure.