Dropping out of school does more than just affect your ability to earn; it also has an effect on whether or not you will develop heart failure following a heart attack.

A Norwegian study of over 70,000 cardiac patients found that the more education they had, the less risk of heart failure.

"Heart failure is a serious complication of acute myocardial infarction and substantially increases the risk of death," said lead author Dr. Gerhard Sulo of the University of Bergen in Norway.

"Previous research has shown that patients are more likely to die after a heart attack if they have a lower educational level, but information on the mechanisms involved is sparse," Sulo said. "Heart failure is the most important incident in the chain of events leading to death after a heart attack, and we hypothesized that it might contribute to the observed educational disparities in survival."

The study included patients aged 35 to 85 years who had been hospitalized with a first acute myocardial infarction (AMI) — heart attack — during 2001 to 2009 and did not have a history of heart failure.

Their education levels were obtained from the Norwegian National Education Database. Education was categorized as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary education (college/university).

Heart failure was divided into two categories; early-onset (heart failure on admission or developing during hospitalization for the AMI) and late-onset (either a new hospitalization with heart failure or death due to heart failure after being discharged from the hospital). Separate analyses were conducted for early and late-onset heart failure.

Of the 70,506 patients included in the analyses, 17.7 percent were diagnosed with early-onset heart failure. Patients with secondary or tertiary education had respectively 9 percent and 20 percent lower risk of heart failure compared to those with primary education.

When analyses were restricted to patients who had surgery to clear blocked arteries after their AMI, those with secondary or tertiary education had respectively 16 percent and 33 percent lower risk of late-onset heart failure compared to those with primary education. The results were the same in both men and women.

"Education per se cannot be considered a 'protective exposure' in the classical sense, but represents a clustering of characteristics that influence health behaviors and outcomes," Sulo said. "It has been shown that patients with lower education tend to delay seeking medical care when heart attack symptoms occur and they have poorer access to specialized care.

"Both of these factors increase the risk of developing early-onset heart failure after AMI,
 he continued. "Those with lower education are more likely to have coexisting medical conditions and unhealthy lifestyles which also increase the risk of heart failure."

"Patients with lower education are less likely to be prescribed medication after a heart attack to prevent heart failure, and they are also less likely to take their medication. This may explain the increased risk of late-onset heart failure," he said.

"Focused efforts are needed to ensure that heart attack patients with low education get help early, have equal access to treatment, take their medications, and are encouraged to improve their lifestyles. This should help reduce the socioeconomic gap in the risk of heart failure following a heart attack," he concluded.

The study was published in the European Journal of Preventive Cardiology.