Heart failure (HF) has become a worldwide public health problem that seriously threatens human's health. Due to "multi-target" effect, traditional Chinese medicine (TCM) has unique advantages in this field. Chinese herb-derived active components would provide valuable candidate compounds for new drug development. Astragaloside IV(AS-IV) is a main effective ingredient of Astragalus membranaceus, a commonly used Chinese patent medicine for the patients with chronic heart failure(CHF). Our aim is to review the recent progresses of AS-IV in HF, and provide potential evidence for its clinical application. Data showed that AS-IV could protect myocardial ischemia, regulate sarcoplasmic reticulum Ca²⁺ pump, promote angiogenesis, improve energy metabolism, inhibit cardiac hypertrophy and fibrosis, reduce myocardial cell apoptosis, etc, which are direct or indirect involved in the beneficial effects of AS-IV in rodents or cellular models of HF. AS-IV or its derivatives may act as a potential therapeutic drug in the clinical treatment of HF.