Objective To analyze the current situation and influencing factors of medication deviation in hospital-home transition period in elderly patients with chronic heart failure (CHF). Methods A total of 178 elderly patients with chronic heart failure were selected as the study objects. General information of patients was collected. The 8-item Morisky Medication Adherence Scale (MMAS-8), Self-Efficacy for Appropriate Medication Use Scale (SEAMS) and family APGAR index questionnaire were analyzed. The occurrence of medication deviation was recorded one week after discharge. The influencing factors of medication deviation in elderly patients with CHF were analyzed. Results Fifty patients (28.09 %) had at least one medication deviation within one week after discharge. A total of 108 cases of medication deviation occurred in 178 patients. The main type of medication deviation was patient-derived causes. Age, quantity of medication in discharge order, medication compliance and family care index were the influencing factors of medication deviation (P < 0.05). Conclusion The occurrence of medication bias in the hospital-family transition period of elderly CHF patients is not optimistic. Medical staff should pay more attention to patients with older-age, a large number of drugs prescribed by discharged doctors, poor medication compliance as well as poor family functions, and take timely targeted measures to ensure medication safety.