OBJECTIVES: To establish the extent to which health inequality operates in a cohort of patients admitted with heart failure to a single centre serving an elderly population. DESIGN: Historical cohort study of patients admitted with a first coded presentation of heart failure. SETTING: Single district general hospital on the South-­‐East coast of England. PARTICIPANTS: 883 patients admitted with a coded diagnosis of heart failure in the first or second diagnostic position. MAIN OUTCOME MEASURES: Mortality, readmission rates, and proportion of patients receiving recommended care. RESULTS: This was an elderly cohort, with a median age of 82.4 years. Just over half were women (51.3%), who tended to be older than men (84 vs. 80 years). Crude mortality rates at 30 days and 1 year were 17% and 38% respectively. All cause readmission at 30 days occurred in 21.3% of cases and the rate of heart failure readmission within 1 year was 35%. The most deprived patients were younger at the time of admission than those from less deprived areas (77.9 vs. 82.3 years [p=0.036]). No association was found between deprivation and mortality but rates of readmission at 30 days were higher in more deprived quintiles(p=0.01). Rates of prescription of beneficial medications were not different between quintiles of deprivation, but significantly lower rates of B-­‐blocker and aldosterone antagonist prescription were observed in the elderly. Comorbidity and left ventricular ejection fraction were also associated with differential rates of prescribing. Provision of echocardiography and documentation of ejection fraction was strongly associated with age as was provision of specialist follow-­‐up. CONCLUSIONS: Hospitalization for heart failure appears to occur at an earlier age in individuals from more deprived areas, but subsequent specialist management is heavily dependent on age, not level of deprivation. This may contribute to poorer outcomes in older individuals admitted with heart failure.