Background: Nowadays, we can see a rapid increase in systolic chronic heart failure patients. Cognitive decline is one of the most frequent and important among geriatric syndromes. Cognitive dysfunction of patients with CHF may lead to mismatch in a therapy prescribed. The aim of the study: To estimate prevalence of cognitive dysfunction in elderly patients with CHF, analyzing cardiac predictors of cognitive decline in this group of patients. Materials and methods: 3 groups of patients were examined. 240 patients with CHF with depressed EF 65+ years old were included in the main group. 2 control groups were presented: one group with patients 65+ years old with no evidence of heart failure (n = 200), another one – patients with systolic CHF (EF<50%) less than 55 years old (n = 200). Results: 82% from patients with systolic CHF had cognitive dysfunction. Patients in the main group had significantly lower MMSE score values compared to both control groups. We have observed a significant direct correlation between EF and MMSE value, an inverse correlation between MMSE and IMMLV, MMSE and SHARE frailty index. EF ≤ 43% in the main group of patients is related with cognitive dysfunction with a sensitivity = 96.94% and specificity = 90.91% (p <0.0001). Conclusion: Cognitive decline is very common in patients with systolic CHF ≥65 years old. Prevalence of cognitive decline is directly related with a value of EF.