Place the Case: Heart Disease and Heart Attack

About Heart Disease & Heart Attack

One of the most common impairments we run into with underwriting is heart disease. It comes in many shapes and forms, as well as degrees of severity.

The broad category of heart disease can include mild issues such as an abnormal EKG, palpitations, mitral valve prolapse, or chest pain (angina). More commonly seen moderate concerns are issues like cardiomyopathy, arrhythmias, and atrial fibrillation. Additionally, we see a high frequency of more severe cases of heart disease such as congestive heart failure, those needing valve replacements and/or pacemakers, and those with histories of myocardial infarctions (heart attacks) with bypass, angioplasty, and/or stenting.

Each of these categories of heart disease — and there are many more — will need to be looked at on a case-by-case basis. Typically, this needs to have the home office underwriter — and more commonly a senior underwriter or medical director — review the complete case to determine an accurate offer. This is not only to assess the severity of the presenting disease, but also to try to find healthy credits or favorable lifestyle characteristics that they may be able to use to improve the offer.

Key Factors for Underwriting Heart Disease

The underwriting of heart disease looks very closely at the cardiac testing results of the EKGs and echocardiograms, as well as stress and treadmill test results. Key factors they’ll be looking at, depending on the impairment or issue at hand, will be ejection fractions, wall thickness, condition and performance of the valves, and basic overall performance of the heart and circulatory system. Obviously, those who are diagnosed with heart disease at an earlier age are going to be more of a concern for possible progression than those that have onset later in life.

Underwriting with a History of Heart Attack

If a case presents with a heart attack history (myocardial infarction aka MI), obviously we know that’s a significant concern; heart attacks are the leading cause of death in America. Typically, after such an event, there’s going to be some kind of treatment to address the stenosis (narrowing of the blood vessels). Usually that will come in the form of coronary artery bypass graft (CABG), angioplasty (ANGP), and/or stenting (also known as percutaneous transluminal coronary angioplasty, or PTCA).

After such an event, we’re typically going to be looking at a six-month postponement, and then a Table 4 (minimum) depending on the condition of the heart and coronary arteries after the event. Also considered is the age of the patient and if there are good cardiac follow-ups and cardiac testing results afterward.

Underwriting: What You Need to Know

The primary questions to be asked of a proposed insured who presents with this history are:

• Age of onset or diagnosis? How long has it been/time since diagnosis?
• What is the specific cardiac issue(s)?
• How is it being treated? Are there good cardiac follow-ups?
• If they’ve had an MI, did they have CABG or PTCA? If so, how many vessels?
• Has recent cardiac testing been favorable? When was last Echo and/or EKG?
• Any family history of CAD?
• Any other significant health issues or impairments?

The underwriting of an applicant with heart disease is very dependent on the individual case, as well as what’s in the doctor's and cardiologist’s notes. Time passed since the event will also be a major factor.

Please see the Heart Disease — Heart Attack Questionnaire, which will help you gather the pertinent info we’ll need to help evaluate your case.

As always, we’re here to help answer your questions about life insurance underwriting for heart disease and heart attack.

Click here to contact our underwriter, Mike Woods, with specific underwriting questions about heart disease and heart attack.