• heart failure with reduced ejection fraction
• epidemiology

As we are almost invariably reminded each time we open a research paper on the subject of chronic heart failure (CHF), the condition is increasingly prevalent and only likely to become so as our population ages.1 In the most recent iteration of the National Heart Failure audit, from 2015 to 2016, data from over 66 000 admissions to hospitals in England and Wales were included; soberingly, this number represents somewhere around 80% of the total for this condition recorded in the first diagnostic position.2 Thus, the societal burden associated with CHF is enormous and growing. Similarly, the individual patient burden associated with a diagnosis of CHF is potentially high; this remains a condition associated with significant morbidity and mortality.

Assessing prognosis for patients with CHF is challenging. A number of risk scores have been developed largely for the estimation of all-cause survival, based on combinations of clinical variables described in populations from clinical trials3 or from large-scale meta-analyses.4 One variable missing from all risk scores for assessment of prognosis in CHF is the influence of socioeconomic status, a factor that we believe to be relevant …