Objective To investigate the current states of negative emotions, quality of life and major adverse cardiovascular events (MACE) in advanced elderly patients with chronic heart failure (CHF) and analyze the influencing factors. Methods A total of 180 very old hospitalized patients (80 years old and over) with heart failure from January 2021 to June 2022 in the First Affiliated Hospital of Xinjiang Medical University were enrolled as the study subjects. Minnesota living heart failure questionnaire (MLHFQ) was used to investigate the negative emotions and quality of life of the participants. SPSS statistics 20.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test, analysis of variance or Chi-square test depending on data type. Pearson or Spearman correlation analyses were applied to analyze the correlations of negative emotions and quality of life with occurrence of MACE. Multivariate linear regression model was constructed to analyze the related factors affecting the quality of life in the advanced elderly patients with heart failure. Results The effective recovery rate of questionnaires was 96.11% (173/180). Our survey found that the total score of MLHFQ was (55.67±10.24) points, and the detection rates of anxiety and depression were 50.87% (88/160) and 41.62% (88/160), respectively, in the subjected advanced elderly patients. Multivariate linear regression analysis showed that the course of CHF >5 years, number of comorbidities >3, and cardiac function grade Ⅳ were influencing factors affecting the MLHFQ score of the patients (Β=6.435,5.151,4.022; all P<0.05). Follow-up revealed that 36 patients (22.50%) experienced MACE events. Correlation analyses indicated that anxiety/depression was positively correlated with MLHFQ score and incidence of MACE events(r=0.377, 0.352；P<0.05), and MLHFQ score was also positively correlated with the incidence of MACE events (r=0.356；P<0.05).Conclusion The advanced elderly patients with heart failure had overall poor quality of life, and anxiety and depression are quite common. Interaction is observed in their quality of life with anxiety/depression symptoms, which is closely associated with MACE events after discharge.