Purpose Beta-blockers were shown to improve the prognosis of patients with acute decompensated heart failure (ADHF) and depressed left ventricular systolic function (DLVSF). Recently, elderly patient���65 years became a main group of ADHF. Clinical impact of beta-blockers in this patients has been rarely evaluated in Korea. Method The Korean Acute Heart Failure (KorHF) Registry enrolled 3,200 patients with ADHF from Nov 2005 to Nov 2009 in South Korea. From KorHF Registry, 1,336 elderly patients ���65 years and DLVSF (EF <50%) were included in this study. They were divided into two groups; no beta-blockers (group 1; n=755, 56.5%) and use of beta-blockers (group 2; n=581, 43.5%) during the index admission. Results Patients in group 1 were older, and had more history of heart failure and arrhythmia, and less COPD. They presented with more severe dyspnea of NYHA function class III and IV. The main underlying heart disease was ischemic heart disease, but it was less frequently found compared with group 2 (41% vs. 55%, p<0.01). Hemoglobin was lower, and NT pro-BNP was higher and LVEF was lower in group 1. Angiotensins converting enzyme inhibitors or angiotensin receptor blockers were similarly used in both groups (70% vs. 73%), but spironolactone was less frequently used in group 1 (26% vs. 32%, p=0.03). Patients in group 1 had lower 1-year survival rate and 1-year event-free survival rate. On multivariate analysis, no use of beta-blockers was still associated with lower 1-year event-free survival (p=0.047). Conclusions Beta-blockers were not used in more than half of elderly patients with DLVSF. Although they present with more severe form of ADHF, selected use of beta-blockers in that situation may improve long-term outcomes.