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Background: The association of influenza vaccination and heart failure (HF) hospitalization and mortality in Thai HF patients is unknown.Objective: To investigate associations between influenza vaccination and all-cause mortality or HF hospitalization in HF patients.Methods: We retrospectively reviewed medical records from two large tertiary care centers in Thailand (Ramathibodi hospital and Maharaj Nakorn Chiang Mai hospital) with newly diagnosed heart failure between 2013-2020 in an outpatient clinic. We examined the relationship between influenza vaccination and outcomes using a propensity-adjusted model.Results: Of 588 patients, 181 (31%) received influenza vaccination. During a mean follow-up of 57 months, influenza vaccination was associated with a 56% reduction in the risk of HF hospitalization or death (HF hospitalization or all-cause death: HR 0.44; 95% CI 0.31-0.63; ppConclusions: In patients with HF, influenza vaccination was associated with a reduced risk of HF hospitalization but not all-cause mortality.