Abstract: Objective To analyze the clinical characteristics of heart failure with normal ejection fraction (HFNEF) in elderly patients. Methods Five hundred and eighty-three elderly patients with their age≥60 years admitted to our hospital from January 2010 to January 2013 were divided into HF group (n=407) and control group (n=176). Patients in HF group were further divided into HFNEF group (n=171) and heart failure with reduced ejection fraction (HFREF) group (n=236). Their laboratory data, basic diseases, echocardiography parameters and drug treatment history were analyzed. Results The age was older, the number of female patients was greater, the systolic blood pressure and serum sodium level were higher, and the incidence of hypertension, atrial fbrillation (AF) and cerebral infarction was higher whereas the incidence of coronary heart disease (CHD), myocardiac infarction and diabetes mellitus (DM) was lower, the number of patients with a drug use history of angiotensin II receptor blockers (ARB) was greater, the number of patients with a drug use history of angiotensin converting enzyme inhibitor (ACEI), diuretics, digoxin and nitric lipids was lower in HFNEF group than in HFREF group (P＜ 0.05). Left ventricular symmetric hypertrophy was detected in HFNEF group with a normal left ventricular diameter and volume. The serum NT-proBNP level and left ventricular mass index (LVMI) were higher whereas the left atrial diameter was longer in HFNEF group than in control group (P＜ 0.01). AF was the independent risk factor for HFNEF in elderly patients (P＜ 0.05). Conclusion About 50% of elderly HF patients suffer from HFNEF. AF is the independent risk factor for such patients.