BACKGROUND Conflicting results currently exist on the clinical use of statins in patients with chronic systolic heart failure (CHF). This study aimed to investigate the effect of statins on clinical outcomes of CHF by a meta-analysis based on randomized controlled trials (RCTs). METHODS We searched PubMed, MEDLINE, EMBASE, and Cochrane databases through 2010 and renewed in February 2011. We included RCTs of subjects who underwent statin or placebo treatment for established CHF, and provided data on clinical outcomes. Risk ratios (RR) were calculated using a random effects model. RESULTS Thirteen trials involving 10,447 CHF patients were included in the meta-analysis. The pooling analysis showed that statin treatment did not significantly reduce the risk of all-cause death (RR=0.93, 95% CI: 0.81-1.07, p=0.31), death for cardiovascular cause or pump failure (p>0.10), and rehospitalization for heart failure (RR=0.90, 95% CI: 0.78-1.04, p=0.15). In addition, statin therapy had a non-significant trend towards reduced risk of nonfatal myocardial infarction (RR=0.84, 95% CI: 0.68-1.02, p=0.08). When restricted to various statins and patients' age, the analysis demonstrated that atorvastatin was associated with reduced all-cause mortality (p=0.009) and readmission rate for heart failure (p=0.005), and the superiority of statin therapy was significant in CHF patients less than 65years (both p<0.01). CONCLUSIONS Although statin has little impact on clinical outcomes in overall CHF patients, statin administration if needed is feasible to CHF patients, and the treatment might be effective when restricted to specific statins or populations.