The clinical end-point of all causes of mortality and cardiovascular hospitalisation (combined end-points) is a widely accepted indicator of heart failure survival. The primary aim of this study was to examine the effects of metoprolol and atenolol on combined end-points in patients with mild-to-moderate heart failure. This study was designed to be comparative, prospective, and random. The criteria for study inclusion were: age of 70 years or less, New York Heart Association (NYHA) Functional Class II and III, and an ejection fraction of the left ventricle of 40% or less. The patients (a total of 150) on therapy with angiotensin-converting enzyme inhibitor and a diuretic were randomised into three numerically equal therapy groups: 1) an atenolol group; 2) a metoprolol group; and 3) a control group (without beta-blockers). The follow-up period was 12 months. The results were analysed using: the hi-square test, variance analyses, Kaplan-Meier's model, Wilcox's statistics, and Cox's model. The cumulative survival rate for patients treated with metoprolol was 88%, 78% for patients treated with atenolol, and 48% for patients from the control group. It is clear that the cumulative survival rate for patients treated with metoprolol and atenolol is significantly higher compared to patients from the control group. In addition, the survival rate of patients treated with metoprolol was considerably higher compared to the survival rate of patients treated with atenolol. Metoprolol has significantly reduced the relative risk of combined end-points (71%) compared to atenolol (53%). The results of this comparative study clearly indicate that metoprolol and atenolol have a favourable effect on the survival rate of patients with chronic heart failure. In addition, metoprolol is considerably more effective than atenolol.