Recent analyses in the temporal trends of mortality and hospitalization in patients with chronic heart failure showed marginal changes in the last 20 years, particularly in the elderly. According to the Euro Heart Survey program and other observational reports, only 37-50% of patients with heart failure are treated with beta-blockers, with a dosage that is approximately half the target dose of clinical trials. The most frequent reason for the limited use of beta-blockers and the suboptimal doses prescribed, is age greater than 70 years. Only two multicenter, double-blind, randomized, placebo-controlled, parallel group trials; the Effects of Nebivolol on Left Ventricular Function in Elderly Patients with Chronic Heart Failure (ENECA) and the Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization Seniors with Heart Failure (SENIORS), both with nebivolol, have been specifically aimed to assess the efficacy of beta-blockade in elderly heart failure patients. The results of such trials demonstrated that the drug is well tolerated and effective in reducing mortality and morbidity, and that the beneficial clinical effect is independent of the baseline ejection fraction.