Abstract Extreme heat events are becoming more frequent and intense. In cities, the urban heat island (UHI) can often intensify extreme heat exposure, presenting a public health challenge across vulnerable populations without access to adaptive measures. Here, we explore the impacts of increasing residential air-conditioning (AC) adoption as one such adaptive measure to extreme heat, with New York City (NYC) as a case study. This study uses AC adoption data from NYC Housing and Vacancy Surveys to study impacts to indoor heat exposure, energy demand, and UHI. The Weather Research and Forecasting (WRF) model, coupled with a multilayer building environment parameterization and building energy model (BEP–BEM), is used to perform this analysis. The BEP–BEM schemes are modified to account for partial AC use and used to analyze current and full AC adoption scenarios. A city-scale case study is performed over the summer months of June–August 2018, which includes three different extreme heat events. Simulation results show good agreement with surface weather stations. We show that increasing AC systems to 100% usage across NYC results in a peak energy demand increase of 20%, while increasing UHI on average by 0.42 °C. Results highlight potential trade-offs in extreme heat adaptation strategies for cities, which may be necessary in the context of increasing extreme heat events.