Five percent of all hospital medical admissions are patients with heart failure. The incidence is about one new case per 1000 of the general population per year, increasing to >10 per 1000 in those aged >or=85 years. Although the evidence that beta-blockers reduce mortality by about 36% when added to angiotensin-converting enzyme inhibitors is overwhelming, clinicians are still reluctant to use beta-blockers in heart failure, especially in older patients. Here, we examine the evidence for the use of beta-blockers in heart failure in older people and explore the practicalities of their use.