OBJECTIVES: The long-term use of ß-blockers has been shown to improve the outcomes of patients with heart failure (HF). However, it is still disputed whether this is a class effect, and, specifically, whether carvedilol or bisoprolol are superior to metoprolol tartrate. The objective of this study is to compare the effectiveness of ß-blockers for patients with HF in a clinical practice. METHODS: We conducted an observational cohort study using the Quebec administrative databases to identify patients with HF who were prescribed a ß-blocker after the diagnosis of HF e.g. metoprolol tartrate, carvedilol or bisoprolol. We used descriptive statistics to characterize the patients by the type of ß-blocker prescribed at discharge. The unadjusted mortality for users of each ß-blocker was calculated using Kaplan-Meier curves and compared using the log-rank test. To account for differences in follow-up and to control for differences among patient characteristics, a multivariate Cox proportional hazards model was used to compare the all-cause mortality, cardiovascular mortality and HF readmission. We run also analysis by matching with a propensity score. RESULTS: Of the 3,732 patients with HF, with a median follow-up of 3.1 years per patient, the crude annual incidence of death was 16.5% with metoprolol tartrate, 15.8% with carvedilol, and 17.5% with bisoprolol. After controlling for several different covariates, we found that carvedilol (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.82-1.10) and bisoprolol (HR 1.06, 95% CI 0.95-1.18) were not superior to metoprolol tartrate in improving survival. Similar results were observed for cardiovascular mortality. But, HF readmission rate was significantly increased from 20 to 26% with carvedilol and bisoprolol compare to metoprolol tartrate. CONCLUSIONS: Based on observational study, we suggest that there is no evidence of a class effect for β-blockers in older patients with HF on mortality, but the choice of ß-blocker may have impact on the rate of HF readmission.