Objective <p>Pneumonia poses a significant risk for triggering heart failure (HF), with a notably higher incidence among older patients. The study aims to assess the efficacy and safety of ambroxol hydrochloride (AH) in older patients with pneumonia complicated with HF.</p> Methods <p>A total of 230 older pneumonia patients with HF were randomly assigned to the control (conventional therapy) and observation (AH injection + conventional therapy) groups. Following a 7-day therapy, pre-/post-treatment Acute Physiology and Chronic Health Evaluation (APACHE) II, Clinical Pulmonary Infection Score (CPIS), inflammatory factor levels, and cardiac function indexes were compared. Clinical efficacy and adverse events (palpitation, vomiting, drowsiness, rash, fatigue, fever, dizziness, and arrhythmia) during treatment were evaluated.</p> Results <p>After 7 days of therapy, both groups showed reduced APACHE II and CPIS scores, left ventricular diastolic diameter, and tumor necrosis factor-α, interleukin-6 (IL-6), and IL-8 levels, and elevated cardiac output and left ventricular ejection fraction. These changes were more pronounced in the observation group, suggesting that AH relieved elder pneumonia complicated with HF, improved pulmonary infection and cardiac function, and suppressed inflammation. The total effective rate was significantly higher in the observation group than in the control group, demonstrating a superior clinical efficacy of AH. Additionally, the adverse event rate was lower in the observation group than in the control group.</p> Conclusions <p>AH alleviated pneumonia concurrent with HF in older people, ameliorated pulmonary infection and cardiac function, decreased inflammatory factor levels, demonstrated better clinical efficacy, and resulted in a lower rate of adverse events.</p>