Aim To investigate the relationship between serum albumin level and long-term prognosis in elderly patients with heart failure and analyze the risk factors of hypoalbuminemia in patients with heart failure. Methods 1048 consecutive elderly patients with heart failure were enrolled, and divided into two groups according to serum albumin concentration:hypoalbuminemia group (serum albumin ＜35 g/L) and normoalbuminemia group (serum albumin ≥35 g/L). Risk factors associated with hypoalbuminemia were analyzed by binary Logistic regression analysis. The primary end point was all cause long-term mortality. COX proportional-hazards regression modeling was used to evaluate the prognostic value of serum albumin for long-term mortality in elderly patients with heart failure. Results Hypoalbuminemia group had higher age, rate of male, NYHA status, direct bilirubin, creatinine, brain natriuretic peptite and C-reactive protein, lower hemoglobin, total cholesterol and serum sodium on admission. Binary Logistic regression analysis revealed that higher NYHA class, higher age, higher brain natriuretic peptite, lower serum sodium, lower total cholesterol and lower hemoglobin were independent risk factors for hypoalbuminemia. The mean follow-up was 20±18 months in 1048 patients. During the follow-up period, 306 patients died, and the mortality was 29.2%. 116 patients died in hypoalbuminemia group, the mortality was 37.7%. 190 patients died in normoalbuminemia group, the mortality was 25.7%. The multivariate COX regression analysis indicated that when albumin decreased by every 1g/L, the risk of long-term death in elderly patients with heart failure increased 3.8% (HR was 1.8,5%CI was 1.007~1.070, P＝0.015), hypoalbuminemia group was associated with a 0.296-fold greater risk of long-term death than normoalbuminemia group (HR was 1.6,5%CI was 1.019~1.648, P＝0.035). Conclusions Serum albumin was an independent risk factor for long-term mortality in elderly patients with heart failure. Multifactors were significantly associated with hypoalbuminemia.