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Background The prognostic value of the geriatric nutrition risk index (GNRI) in critically ill patients with heart failure (HF) remains unclear, despite its established association with mortality in critically ill patients with HF.Objective To investigate the association between GNRI and mortality and evaluate the additive value of GNRI for predicting mortality in critically ill patients with HF.Methods This retrospective cohort study analysed 4058 patients aged ≥65 years with HF from the Medical Information Mart for Intensive Care IV database. GNRI was categorised into GNRI >98 (no malnutrition risk) and GNRI ≤98 (at risk of malnutrition). Associations between GNRI and in-hospital, 30-day and 1-year mortality were evaluated using logistic regression, Cox proportional hazards models and restricted cubic spline analyses. Subgroup and sensitivity analyses assessed robustness, while receiver operating characteristic curves compared the predictive performance of Sequential Organ Failure Assessment (SOFA) scores with and without GNRI.Results The overall mortality rates were 27.1% (in-hospital), 32.8% (30-day) and 53.4% (1-year). Patients with GNRI >98 had significantly better survival odds for in-hospital mortality (OR=0.70, 95% CI 0.61 to 0.80) and higher mortality risks for 30-day (HR=0.67, 95% CI 0.60 to 0.75) and 1-year (HR=0.67, 95% CI 0.61 to 0.73) outcomes, even after adjusting for confounders. Restricted cubic spline analysis revealed an L-shaped association between GNRI and in-hospital/1-year mortality, while a linear relationship was found for 30-day mortality. Adding GNRI to SOFA scores was significantly associated with enhanced predictive accuracy across all outcomes (areas under the curve (AUCs)=0.724, 0.724, 0.706 and 0.670 for in-hospital, 30-day and 1-year mortality, respectively).Conclusions GNRI is associated with mortality in critically ill patients with HF and improves SOFA score accuracy, supporting its integration into routine assessments to enhance risk stratification and inform clinical decision-making.