There has been growing interest in and recognition of the role of β-blockers in chronic heart failure (CHF). The mode of action is complex and several mechanisms have been proposed. The principal rationale for the use of β-blockade is to counteract neurohormonal activation and its deleterious consequences in CHF. While the positive effect of this treatment on haemodynamics, exercise tolerance and quality of life, and a clear trend in favour of improved prognosis have been shown, there is still no concrete proof that β-blockers reduce mortality in CHF. Several large-scale, prospective, randomised, placebo-controlled trials, designed to provide a definitive answer, are underway.