beta-Blocker therapy has changed the landscape of treatment for chronic heart failure (HF). First recommended in published guidelines in 1999, the use of beta-blockers has become the cornerstone of therapy. beta-Blockers reduce both morbidity and mortality and also improve quality of life. This paper reviews and highlights the evidence supporting the current usage of beta-blockers in HF. It also shares practical, real world tricks-of-the-trade regarding such usage drawn from 8 years of experience with over 3000 patients in eight safety net hospitals. Each hospital mentioned in this paper participates in an HF disease management program serving the needs of Louisiana's indigent population.