Prof Prescott said: "There are two important findings from this study. The first is that the clear socioeconomic gradient in risk of developing heart failure found in this and in other studies is not explained by differences in lifestyle. Thus, we must look for other explanations, which potentially include differences in treatment of patients; for instance, perhaps the socioeconomically deprived do not receive the same standard of treatment as the more affluent. We cannot conclude this based on our study but we can see that we must look for explanations other than 'poor behaviour'. The other important finding is that the socioeconomic gradient was seen in echocardiographic indicators of both systolic and diastolic dysfunction. Previous studies have not been able to differentiate between systolic and diastolic heart failure, which have different pathways, but this study points toward a socioeconomic gradient in both subgroups of heart failure.

"In addition, since we were using echocardiography to look at early indicators of heart dysfunction in healthy individuals, we were able to show that the socioeconomic gradient is present from early disease stages, years or decades before development of clinical heart failure. By adding echocardiography to this study we have a more 'objective' measure than hospital admission. Whether or not you are admitted to hospital for treatment not only depends on disease severity but also on the individual threshold for admission; for example, if you have someone at home to look after you, you may be less likely to be admitted. This could be a source of error in studies such as this. The echocardiography overcomes this problem."

The study does not show what could be the mechanism by which social deprivation is associated with an increased risk of heart failure. "We need more studies on this, but possible explanations could include differences in heart failure treatment as already mentioned, but we must also look for explanations at the pre-clinical stages. One point to be mentioned is the role of psychosocial stress on development of heart failure - this has received very little scientific attention so far."  

Prof Prescott concluded: "This study shows that deprivation, as measured by levels of education, should be regarded as a risk factor for chronic heart failure in line with what is already known for coronary heart disease, and policy makers should be aware of this when planning social and healthcare provision."

Source: European Heart Journal