Background: The longitudinal pattern of β-blocker use in a heart-failure practice setting has not been explored. Previous studies have not specifically addressed the use of β-blockers over time to determine the rate of use and reasons for discontinuation. The long-term compliance rate for β-blocker drugs outside the context of a clinical trial has not been established. Methods: We prospectively followed a cohort of 500 consecutive patients between March and May 2001, with a clinical diagnosis of chronic heart failure seen in a specialized heart failure clinic and determined the longitudinal pattern of β-blocker use and clinical outcomes over a 2-year period. Results: The final cohort consists of 340 patients with a complete 2-year follow-up data (mean age 61 ± 14 years, 69% men, 53% with ischemic etiology, mean ejection fraction 27.6 ± 15%). At 6, 12, and 24 months, β-blocker utilization rates were maintained in 69%, 70%, and 74% of patients, respectively. Of the 120 confirmed initial non-β-blocker users, 28 (23%) were subsequently started on β-blocker, despite suspected relative contraindications in 53% of patients. Over a period of 2 years, the discontinuation rate was 10%, with failure to restart a β-blocker after hospitalization as the most common reason for β-blocker discontinuation. Conclusion: Utilization rates of β-blockers in our heart failure clinic have remained constant at approximately 70% throughout a 2-year follow-up. Of those who discontinued β-blockers (10%), the most common documented cause was failure to restart β-blockers after hospitalization.