OBJECTIVES: To examine the relationship between road traffic noise exposure and heart failure. STUDY DESIGN: A systematic review and meta-analysis was conducted. METHODS: We systematically searched eight databases (PubMed, Embase, Scopus, Cochrane, Web of Science, CNKI, Wanfang Data, and Chinese Biomedical Literature Database) through July 2024 to identify cohort studies on road traffic noise exposure and heart failure according to a priori inclusion criteria. The random effect model was adopted to summarize the effect estimates. Using the piecewise linear model, the dose-response relationship between road traffic noise exposure and heart failure was also estimated. RESULTS: This meta-analysis included eight cohort studies including 8,601,385 participants and 221,842 patients with heart failure. Overall, higher road traffic noise exposure was associated with an increased risk of heart failure (pooled HR = 1.12, 95 % CI: 1.06-1.18) with high heterogeneity (I CONCLUSIONS: The existing evidence showed a significant correlation between road traffic noise exposure and the incidence of heart failure. Further studies are required to explain the potential biological mechanisms.