The well established benefits of beta-blocker therapy in chronic heart failure include improved survival and quality of life and decreased morbidity and hospitalizations. In acute heart failure, evidence supports early initiation of beta-blocker therapy within the same hospitalization. Beta-blocker therapy seldom has to be withdrawn if patients are already on this medication as maintaining beta-blockers throughout these episodes is not deleterious and increases ulterior therapeutic adhesion. Possible indications for temporarily discontinuing therapy are a worsening clinical condition or cardiogenic shock. Potential benefits of maintaining beta-blockers on mortality still have to be confirmed by larger prospective trials.