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 whether carvedilol or bisoprolol are superior to metoprolol tartrate. Our objective was to compare the effectiveness of ß-blockers for older patients following a primary hospital admission for HF. METHODS:  We conducted a cohort study using Quebec administrative databases to identify patients who were prescribed the ß-blockers, carvedilol, bisoprolol or metoprolol tartrate after the diagnosis of HF. We characterize the patients by the type of ß-blocker prescribed at discharge of their first HF hospitalization. To control for differences among patient characteristics, a multivariate Cox proportional hazards model was used to compare the primary endpoint of all-cause mortality and the secondary endpoint of HF readmission. We conducted analyses by matching for a propensity score for initiation of β-blocker therapy. RESULTS:  Of the 3197 patients with HF with a median follow-up of 2.8 years, the crude annual mortality (per 100 person-years) was 16, 14.9 and 17.7 for metoprolol tartrate, carvedilol, and bisoprolol, respectively. After controlling for covariates, we found that carvedilol (HR 0.92; 0.78-1.09) and bisoprolol (HR 1.04; 0.93-1.16) were not superior to metoprolol tartrate in improving survival. After matching for propensity score, carvedilol and bisoprolol shown no additional benefit on all-cause mortality and HF readmission compared to metoprolol tartrate. CONCLUSIONS: We suggest that there is no evidence of a differential effect of β-blockers on all-cause mortality and HF readmission in older patients with HF.