BACKGROUND: Heart failure (HF) is a disease closely linked to metabolic disorders, and the serum uric acid to high-density lipoprotein cholesterol ratio (UHR) is acknowledged as a potential inflammatory and metabolic marker. However, the association between UHR and HF remains unclear. METHODS: This cross-sectional study examined the association between serum UHR and HF in a cohort of 28,169 participants drawn from the National Health and Nutrition Examination Survey (NHANES) 2003-2018 database. Logistic regression analyses, both univariate and multivariate, along with subgroup analyses, were conducted to assess the relationship between UHR and the risk of HF, the robustness of the results, as well as potential influencing factors. Additionally, we also evaluated the nonlinear relationship between UHR and HF using restricted cubic spline analysis. RESULTS: Following the adjustment for all confounding variables, multivariate analysis revealed that LnUHR remained positively correlated with HF (Model 3, OR = 1.82, 95% CI: 1.32-2.52, p < 0.001), with higher LnUHR levels associated with increased risks of HF (Q4 vs. Q1, OR = 1.71, 95% CI: 1.16-2.52, p < 0.01). Subgroup analyses demonstrated that the association between LnUHR and HF stayed stable across most groups. Furthermore, the relationship between LnUHR and HF exhibited a positive nonlinear trend, with an inflection point at 5.52. CONCLUSION: This study further confirmed that LnUHR is positively associated with HF, emphasizing the potential value of LnUHR as a composite biomarker of HF. Additional large-scale prospective studies are required to validate our findings and clarify underlying mechanisms through further investigation.