Background To document the pharmacotherapy of chronic heart failure (CHF) and to evaluate the adherence to treatment guidelines in Australian population. Methods The pharmacological management of 677 patients (female 46.7%, 75.5 +/- 11.6 years) with CHF was retrospectively analyzed. Results The use of angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and beta-blockers were 58.2 % and 34.7 %, respectively. Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatinine level. For patients who did not receive beta-blockers, asthma and chronic obstructive pulmonary disease were the main contraindications. Treatment at or above target dosages for ACE inhibitors/ARBs and beta-blockers was low for each medication (40.3% and 28.9%, respectively). Conclusions Evidenced-based medical therapies for heart failure were under used in a rural patient population. Further studies are required to develop processes to improve the optimal use of heart failure medications.