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Morphine has been considered as an important medicine to treat acute heart failure (AHF) for a long time. This study was designed to explore the usage rate of morphine in emergency department and its influence on the prognosis of the elderly patients with AHF in china. A prospective investigation of elderly patients with AHF, who were treated and admitted from emergency room of the General Hospital of the People's Liberation Army (GHPLA) in China, were performed. The patients were divided into two groups: control group and morphine treatment group. The relationships between the usage of morphine and clinical factors such as demographic characters of patients and past history were analyzed. The effect of morphine on mechanical ventilation, hospitalization stay and the mortality of patients were also evaluated. The usage rate of morphine was 50% in the emergency room. The patients on the morphine treatment group were more likely to have past history of coronary heart disease, type 2 diabetes mellitus (T2DM) and stroke than those of the control group (p < 0.05). The patients on morphine treatment group had higher troponin-T values compared with those of the control group (p < 0.05). Morphine usage was not an independent risk factor of mortality (OR: 2.172, p: 0.187, 95% CI: 0.686 to 6.879). The Odd ratio of morphine usage for mechanical ventilation incidence was 3.01 (95%CI, 1.22 to 7.41). High prevalence of morphine usage was found in the elderly AHF patients from emergency room of GHPLA in China. Morphine is still a safe medicine in early treatment on the elderly patients with AHF with mechanical ventilation in China. Key words: Morphine, acute heart failure, mechanical ventilation, mortality.