Objective To observe the changes of plasma brain natriuretic peptide(BNP) and norepinephrine(NE) levels in elderly patients with acute heart failure(AHF), and evaluate their roles to predict the prognosis. Methods Totally 117 elderly patients with AHF were enrolled. The plasma levels of BNP and NE were determined at admission, the third day and discharge respectively. All patients were followed up for three months to evaluate the cardiac events after discharge. Receiver operation characteristic(ROC) curves were used to analyze the abilities of plasma BNP and NE levels to predict the prognosis of the patients. Results Plasma BNP and NE levels markedly decreased on the third day in all patients [BNP: (781±580) vs (1368±939)ng/L; NE: 163(109,281) vs 295(174,509)ng/L; P＜0.05]. Plasma NE level decreased subsequently (P＜0.05). Before discharge, plasma levels of BNP and NE were correlated to patients￠ prognosis. Plasma levels of BNP and NE were significantly higher in event group than in non-event group(P＜0.05). Area under ROC curves was 0.721 for BNP and 0.739 for NE respectively. Plasma BNP and NE levels had moderate accuracy to predict cardiac events after discharge. Plasma NE level had better accuracy than plasma BNP level. The incidence of cardiac events and mortality were higher in decompensated congestive heart failure(CHF) patients than in AHF patients(P=0.008, P=0.035). Conclusion The plasma levels of BNP and NE before discharge are predictive of prognosis of elderly patients with AHF. NE has better accuracy than BNP. Decompensated CHF patients have higher plasma levels of BNP and NE, and higher incidence of cardiac events than AHF patients.