 |
1.5 million heart attacks occur in the United States each year with 500,000 deaths.
Almost 14 million Americans have a history of heart attack or angina. |
Heart attacks are a familiar finding among applicants 50 and over who are applying for life insurance. A large segment of these applicants are insurable assuming the damage to heart has been kept to a minimum and their cardiac risk factors have been modified. The following screening questions will help producers in the initial screening of applicants with history of heart attack.
1) Does the client currently smoke?
Underwriting Comment: Clients who have had heart attacks and continue to smoke may not be insurable. Smoking is a major risk factor for heart disease and one that can have a dramatic impact on outcome (i.e. life expectancy). The good news is that smokers who quit following a heart attack have better survival rates and better pricing for life insurance.
2) When did the client have the heart attack?
Underwriting Comment: Clients with uncomplicated heart attacks (also called myocardial infarction, literally meaning to strike heart muscle dead) may be insurable as early as 3 to 6 months following the actual event.
3) How was the heart attack treated?
Underwriting comment: There are essentially three (3) treatment options for clients who have heart attacks:
- Clot dissolving therapy to interrupt the actual heart attack.
- Angioplasty or PTCA (balloon expansion of a blocked artery usually using a metal-stent to keep the artery open, see this link for a discussion of PTCA http://www.risktutor.com/demo/newsletters/11_03/).
- Coronary bypass surgery.
It is important to know what treatment option the client had to accurately assess the risk. Please note that it is possible for a client to have all three options in the treatment of a heart attack. Clot dissolving therapy could be used initially to abort the heart attack. The blocked artery could then be opened using balloon angioplasty. The angioplasty could prove ineffective (i.e. the open artery could close) and bypass surgery ultimately used to solve the blocked artery problem.
4) Has the client had any chest pain or other heart symptoms since the heart attack?
Underwriting comment: Chest pain or other cardiac related symptoms (i.e. irregular heart rhythm, weakness, etc.) after a heart attack carries with it a marked increase in mortality. Clients who report pain or other cardiac related symptoms in the post-heart attack period are universally uninsurable for individual coverage.
5) Has the client had any follow-up cardiac tests since his or her heart attack (i.e. treadmill ECG, thallium treadmill, stress-echo treadmill)? If yes, was he or she told the results were "normal?"
Underwriting Comment: Follow-up cardiac testing provides objective evidence of the client’s cardiac status post-heart attack. Thallium treadmills and stress-echo treadmills provide more useful information than a basic treadmill ECG. Any follow-up cardiac testing that is abnormal will result in the client being highly rated or declined for individual coverage.
6) What medications is the client currently taking?
Underwriting comment: Uncomplicated heart attacks are usually managed with minimal medications such as aspirin, though protocols can differ among cardiologists. Complicated heart attacks, however, are managed with stronger medications such as Lanoxin, Lasix, Imdur, Isordil or nitroglycerin. Knowledge of the client's current medications is mandatory for an accurate risk assessment.
7) Is the client currently involved in any form of cardiac rehabilitation or undergone any lifestyle changes (i.e. quit smoking, began an exercise program, changed diet, etc.)?
Underwriting Comment: Lifestyle changes can have an enormous positive impact on the underwriting outcome for a cardiac case. There are excellent medical studies that verify that mortality outcome is greatly improved with positive lifestyle changes such as quitting smoking or beginning an exercise program. It is important that you document all lifestyle changes that would indicate a decrease in any cardiac risk factors.
