Background Socioeconomic disadvantage is associated with an increased risk of developing heart failure and with inferior health outcomes following diagnosis. Methods Data for hospitalisations and deaths due to heart failure in the Sydney metropolitan region were extracted from New South Wales hospital records and Australian Bureau of Statistics databases for 1999-2003. Standardised rates were analysed according to patients' residential local government area and correlated with an index of socioeconomic disadvantage. Results Eight of the 13 local government areas with standardised separation rate ratios significantly higher than all NSW, and those with the six highest standardised separation rate ratios, were in Greater Western Sydney. Rates of heart failure hospitalisations per local government area were inversely correlated with level of socioeconomic status. Conclusions Higher rates of heart failure hospitalisations among residents of socioeconomically disadvantaged regions within Sydney highlight the need for strategies to lessen the impact of disadvantage and strategies to improve cardiovascular health.