Systolic heart failure (SHF) is associated with increased morbidity and mortality. Beta-blockers (BB) were shown to provide mortality benefit in patients with SHF, and currently indicated in all stages of patients with SHF. We evaluated the factors influencing the prescription of BBs at discharge in patients hospitalised with HF. Hospital discharge records of consecutive 1418 patients (996 men, 422 women) with a mean age of 57 +/- 15 years, hospitalised and treated for SHF (EF < 45%), were retrospectively reviewed. Mean age of female (n = 422) and male patients (n = 996) was similar (58 +/- 15 years vs. 58 +/- 14 years, p = 0.654). Mean EF was 33 +/- 7%, and not different for each sex (p = 0.288). BBs were present in 47.4% of patients at hospital discharge, and female patients were more frequently prescribed than men (51.7% vs. 45.7%, p = 0.036). Patients who were prescribed BBs at discharge were younger than those who were not (p = 0.034). Patients who were prescribed BBs at discharge had significantly higher EF than those who were not (p = 0.019). Older patients were prescribed low-dose BBs. Besides, creatinine level was significantly higher in the group who were prescribed low-dose BBs than those who were prescribed high dose. However, EF was significantly lower in the group, who were prescribed low-dose BBs than in those prescribed moderate-high dose (33 +/- 7% vs. 35 +/- 7%, p = 0.023). There exist several factors associated with underuse of this highly recommended medication in patients with HF.