BACKGROUND: Geriatric Nutritional Risk Index (GNRI) is a promising tool for predicting nutrition-related complications. This meta-analysis sought to determine the prognostic utility of GNRI in elderly patients with heart failure. METHODS: We comprehensively searched the PubMed and Embase databases from their inception to July 2019. Original studies investigating the prognostic value of GNRI in patients with heart failure were included. Outcome of interests were all-cause mortality and major cardiovascular events. The prognostic value of GNRI was expressed as risk ratios (RR) with 95% confidence intervals (CI) for the lowest versus the highest GNRI category or continuous GNRI analysis. RESULTS: Eleven articles (10 studies) involving 10,589 elderly heart failure patients were included. Meta-analysis indicated that heart failure patients with the lowest GNRI had an increased risk of all-cause mortality (RR 2.11; 95% CI 1.72-2.58) and major cardiovascular events (RR 2.00; 95% CI 1.24-3.22) after adjustment for confounding. In addition, each unit reduction in GNRI significantly increased 6% risk of all-cause mortality. CONCLUSION: Lower GNRI independently predicts all-cause mortality and major cardiovascular events in elderly patients with heart failure. Determination of nutritional status using GNRI may improve risk stratification in elderly patients with heart failure.