A recent individual patient data meta-analysis has shown that beta-blockers reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) who are in sinus rhythm but not in those who are in atrial fibrillation. Similar results applied also to cardiovascular death or first hospitalization for heart failure. The European Society of Cardiology guidelines recommend beta-blockers in patients with HFrEF regardless of baseline rhythm. However, despite improving symptoms, the prognostic benefits of beta-blockers have now been questioned by these authors in patients with HFrEF and atrial fibrillation. In this review we comment the findings of this study
