Therefore, the committee agreed to make a research recommendation for a prospective RCT to be undertaken to determine whether or not beta-blockers should be given to patients with HF-REF and AF. Trade-off between net clinical effects and costs No relevant economic studies were identified from the published literature. Unit costs of beta-blockers, the costs for heart-failure related hospitalisation and stroke were therefore presented to the committee for consideration of cost-effectiveness. The committee noted the high cost of low dose (2.5mg) Nebivolol, however, this beta-blocker is not commonly prescribed. If used, it is often a higher dosage that is split to gain the required dose; therefore this high cost is not always incurred. The committee discussed and agreed that an up-titration appointment would likely occur every 2 weeks and would most likely be in a community setting with a specialist nurse. The committee agreed a conservative appointment time of 30 minutes. The committee agreed to the chosen HRG codes for heart failure hospitalisation, and decided that a weighted average of these codes based on activity would be the most suitable as an average cost of heart failure hospitalisation. The committee stated that stroke events in patients with chronic heart failure and AF are likely to be of greater severity and therefore of higher cost. Given that the committee found that the clinical evidence for the use of beta-blockers compared with placebo for all outcomes was highly uncertain, the committee could not determine cost-effectiveness with any certainty, and therefore agreed to incorporate this in the research recommendation. Other considerations The committee decided only to review the evidence in the HF-REF and AF population, and not the HF-PEF and AF population, because there is no prognostic evidence for use of beta-blockers in HF-PEF. 