Objective: To investigate the clinical efficacy and safety of Tongxinluo capsule combined with dapagliflozin in the treatment of elderly patients with type 2 diabetes mellitus (T2DM) complicated with chronic heart failure (CHF). Methods: A total of 82 elderly patients with T2DM complicated with CHF who were diagnosed and treated in the geriatrics department of our hospital from May 2022 to April 2025 were included in this study and randomly divided into two groups (n=41). All subjects received standardized basic treatment. The control group was orally administered dapagliflozin (5 mg·time-1, 1 time·d-1), while the observation group was orally administered Tongxinluo capsules (3 capsules·time-1, 3 times·d-1) on this basis. Both groups were treated continuously for 6 m, and the clinical efficacy of the two groups was evaluated. Before treatment and 6 m after treatment, fasting plasma glucose (FPG) and 2-hour postprandial glucose (2 hPG) were detected by the glucose oxidase method, glycated hemoglobin A1c (HbA1c) was detected by high performance liquid chromatography, the left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD) and interventricular septal thickness (IVST) were measured by color doppler, serum N-terminal pro-b-type natriuretic peptide (NT-proBNP) was detected by chemiluminescence method, the serum levels of interleukin-6 (IL-6), tumor necrosis factor - α (TNF - α) and soluble suppression of tumorigenicity 2 (sST2) were detected by enzyme linked immunosorbent assay, the diabetes-specific quality of life scale (DSQL) and minnesota living with heart failure questionnaire (MLHFQ) were used to evaluate the quality of life. The adverse reactions of the two groups were compared. Results: The total effective rate of the observation group was significantly higher than that of the control group (97.56% vs. 80.49%, P<0.05). After treatment, the FPG, 2 hPG, HbA1c, LVESD, LVEDD, IVST, serum NT-proBNP, IL-6, TNF-α, sST2 levels and DSQL and MLHFQ scores in the observation group were significantly lower than those in the control group (P<0.05), and LVEF was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Tongxinluo capsule combined with dapagliflozin can improve blood glucose, cardiac function and inflammatory indexes, and improve the quality of life in elderly patients with T2DM complicated with CHF.