Abstract: Objective To study efficacy and safety of lyophilized recombinant human brain natriuretic peptide (rhBNP) in the treatment of chronic congestive heart failure (CHF) in the very old patients. Methods Totally 47 cases of senile chronic CHF in Anhui Provincial Hospita ICU from November 2016 to November 2017 were collected. All the patients were treated with rhBNP in addition to routine heart failure therapy. The clinical effects were evaluated mainly according to the clinical symptoms before the treatment, 72 hours and 7 days after the treatment, including N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, central venous pressure(CVP), serum hypersensitive c-reactive protein(hsCRP), white blood cell count (WBC), respiratory rate (RR), heart rate (HR), urine volume and systolic blood pressure. Results Among the 47 patients, 43 of them showed obvious improvement in cardiac function, while 3 cases showed minor improvement, 1 case died of infection aggravation on the 12th day of hospitalization. The respiratory rate, heart rate, urine volume and LVEF at 72 hours after the treatment showed significant improvement, NT-proBNP, CVP, hsCRP and white blood cell count reduced greatly at 72 hours after the treatment(P<0.05). The improvement of respiratory rate, heart rate and LVEF continued 7 days after the treatment, the reduction of NT-pro BNP, CVP and hsCRP became significant after 7 days(P<0.05). The urine volume remained stable 7 days after the treatment. The white blood cell count remained stable 7 days after the treatment. There were no obvious changes in the serum creatinine, urea nitrogen and glutamic-pyruvic transaminase(P>0.05). Transient low blood pressure could be detected in the treatment, but the incidence was low. Conclusion The rhBNP on CHF in very old patients is effective and safe.