Objective To observe the therapeutic effect of empagliflozin（EMPA） on elderly patients with type 2 diabetes mellitus（T2DM） and heart failure（HF）and its influence on myocardial energy metabolism of patients. Methods The clinical data of 116 elderly patients with T2DM complicated with HF treated in the Department of General Medicine of Suining Central Hospital were retrospectively analyzed from July 2019 to June 2022, and the patients were randomly divided into conventional group（conventional treatment） and EMPA group（EMPA treatment） by single-double ball method, with 58 cases in each group. Before treatment and after 12 weeks of treatment, the two groups of patients were compared in terms of glucolipid metabolism, insulin resistance, cardiac function, myocardial injury and myocardial energy metabolism, and the adverse reactions were statistically analyzed. Results The levels of FPG, HbA1c, TC, TG, HOMA-IR, LVESD, LVEDD, BNP, cTnI, CK-MB and FFA in EMPA group were lower than those in conventional group（all P＜0.05）. HOMA-β and LVEF were higher in EMPA group compared to conventional group（all P＜0.05）. The total incidence rate of adverse reactions with 3.45% in EMPA group was not statistically different from 10.34% in conventional group（P＞0.05）. Conclusion EMPA has a significant effect in the treatment of T2DM with HF in elderly patients, and it can regulate glucolipid metabolism, alleviate insulin resistance, and improve cardiac function and myocardial metabolism. In addition, it does not increase the incidence rates of adverse reactions