Objective: To observe the effects of enhanced external counterpulsation (EECP) on quality of life, cardiac function, and cognitive function in patients with heart failure complicated cognitive impairment. Methods: Ninety patients were randomly assigned to either a control group or an observation group, with 45 patients in each. The control group received standard heart failure treatment, while the observation group received EECP in addition to the standard treatment. After 7 weeks of treatment, comparisons were made between the two groups regarding the Minnesota living with heart failure questionnaire (MLHFQ) score, left ventricular ejection fraction (LVEF), 6-minute walking distance (6MWD), ratio of early to late diastolic ventricular filling velocities (E/A ratio), New York Heart Association (NYHA) functional classification, left ventricular end-diastolic dimension (LVEDD), N-terminal pro- B-type natriuretic peptide (NT-proBNP) levels, high-sensitivity C-reactive protein (hs-CRP) levels, 30-day readmission rate, activities of daily living (ADL) scale score, and Montreal cognitive assessment (MoCA) score. Results: After treatment, the MLHFQ scores decreased in both groups, with a more significant decrease observed in the EECP group (P<0.05). Regarding cardiac function, the EECP group showed superior improvement in LVEF, 6MWD, E/A ratio, and NYHA classification, as well as a greater reduction in LVEDD, NT-proBNP, and hs-CRP levels compared to the control group (P<0.05). However, no statistically significant difference was found in the 30-day readmission rate between the two groups (P>0.05). Regarding cognitive function, the MoCA scores increased and ADL scores improved more significantly in the EECP group compared to the control group (P<0.05); the control group showed no significant change in MoCA scores. Conclusion: EECP is beneficial for improving quality of life, cardiac function, and cognitive function in patients with heart failure complicated by cognitive impairment.