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ObjectiveCongestive heart failure (CHF) is a chronic disease marked by impaired cardiac function, and excess visceral fat has been reported to be associated with CHF. While the age-adjusted visceral adiposity index (AVAI) is a novel metric for evaluating visceral fat, its association with CHF has not been well elucidated.MethodsThe association between AVAI and CHF prevalence was assessed using cross-sectional data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES). Logistic regression was used to assess the association between AVAI and CHF prevalence, with sequential adjustment for covariates. Subgroup analyses stratified by demographic variables and lifestyle factors were done to examine the robustness of the results. Lastly, the discriminative ability of VAI and AVAI in distinguishing individuals with and without prevalent CHF was evaluated using receiver operating characteristic (ROC) curve analysis.ResultsA total of 6,695 participants were included in the analysis, comprising 6,470 without CHF and 225 with CHF. Logistic regression revealed a significant positive association between AVAI and CHF prevalence (OR = 1.75, 95% CI: 1.62-2.89), which remained robust after adjusting for confounders (adjusted OR = 1.57, 95% CI: 1.31-1.87). In subgroup studies, AVAI was consistently associated with the prevalence of CHF. ROC analysis indicated that AVAI demonstrated superior discriminative performance compared with VAI in distinguishing individuals with and without prevalent CHF.ConclusionsThis cross-sectional study identified a significant association between AVAI and prevalent CHF. AVAI may represent a clinically relevant marker associated with the prevalence of CHF and may help identify populations with a higher likelihood of prevalent CHF for further prospective investigation.