Fear of progression is common in older patients with chronic heart failure. To elucidate the underlying mechanism between illness perception and fear of progression is important. This study aims to explore the relationship between illness perception and fear of disease progression among elderly patients with chronic heart failure, as well as the chain mediating role of social support and resilience. A cross-sectional survey on 248 hospitalized older patients with chronic heart failure were recruited. Brief Illness Perception Questionnaire, Perceived Social Support Scale, The-Connor-Davidson Resilience Scale, and Fear of Progression Questionnaire-Short Form were used. PROCESS macro for SPSS was used to validate the pathways. The findings indicated a positive association between illness perception and fear of progression, whereas social support and resilience exhibited a negative correlation with fear of progression. Illness perception not only impacted fear of progression directly, but also had an indirect influence through three avenues: (1)social support, (2)resilience, (3)chain combination of social support and resilience. Therefore, attention should be paid to improving patients' fear of progression through improving patients' social support and resilience.Copyright © 2025 Elsevier Inc. All rights reserved.