Objective To investigate the incidence of cognitive impairment in the elderly patients with chronic heart failure (CHF), and to analyze the clinical characteristics of those suffering from CHF accompanied with cognitive impairment. Methods A retrospective study was carried out on 180 elderly CHF patients who were hospitalized in our health care center from January 1,5 to March 1,6. According to Montreal cognitive assessment, they were divided into 3 groups:normal group (n=44), mild cognitive impairment group (MCI, n=75) and severe cognitive impairment group (SMI, n=61). The clinical characteristics were compared among the 3 groups. SPSS statistics 17.0 was used for data processing. The comparison between the groups was performed by F test or by Chi-square test. Multivariate logistic regression analysis was carried out for single factor analysis with statistical significance, and then independent risk factors were screened out. Results The incidence rate of cognitive impairment was 75.6% (136/180) in the subjected elderly CHF patients. Compared with the normal group, the ratio of those at New York Heart Association (NYHA) Ⅲ was significantly larger in the MCI and SMI groups (47.54% vs 21.33% vs 13.64%, P<0.05). The SMI group had obviously more female patients (55.74% vs 38.64%), higher percentage of patients with education level lower than high school (36.07% vs 13.64%), and higher blood glucose level [(5.88±2.38) vs (5.10±0.74) mmol/L, all P<0.05], but notably lower hemoglobin level[(131.50±15.89) vs (122.80±15.61)g/L, P<0.05]when compared with the normal group. The ratios of NYHA Ⅲ (47.54% vs 21.33%), female patients (55.74% vs 32.00%) and lower educational level than high school (36.07% vs 17.33%) were significantly larger in the SMI group than in the MCI group (P<0.05). Left ventricular ejection fraction (LVEF) in the SMI group was significantly lower than those of the normal group and MCI group [(61.72±7.81)% vs (64.89±6.58)% vs (64.07±5.88)%, P<0.05]. Multivariate logistic regression analysis showed that NYHA Ⅲ level (95%CI:1.21-13.61), and low hemoglobin level (95%CI:0.94-0.99) were independent risk factors for MCI (P<0.05), while NYHA Ⅲ level (95%CI:1.73-21.98), low hemoglobin level (95%CI:0.93-0.99), female (95%CI:0.15-0.96), lower educational level than high school (95%CI:1.36-13.76) and low LVEF (95%CI:1.00-1.15) were independent risk factors for SMI (P<0.05). Conclusion The elderly CHF patients commonly suffer declined cognitive function. Those patients with cognitive impairment are characterized by female, low educational level, poor heart function classification, high blood glucose, low hemoglobin level and LVEF.