An underwriter's view: Coronary Heart Disease

VitalityLife’s Director of Underwriting & Claims John Downes looks at the underwriting implications for coronary heart disease (CHD) and coronary artery bypass surgery.

Heart and circulatory diseases

More than a quarter of deaths in the UK are caused by heart and circulatory diseases. That’s almost 170,000 deaths each year – an average of 460 deaths each day or one every three minutes. CHD is the most common type of heart and circulatory disease and the most common cause of heart attack¹.

CHD generally affects more men than women, although from the age of 50 the chances of developing the condition are similar for both sexes. Apart from chest pain (angina pectoris), the main symptoms of CHD are heart attacks and heart failure.

Lifestyle factors such as obesity, smoking, physical inactivity and poor diet increase the risk of getting the disease. At VitalityLife we aim to reduce the chances of our members getting CHD by providing rewards and benefits that encourage them to be more physically active, improve their nutrition and stop smoking. Exercising just one to two times a week reduces the chances of death from heart disease by 41%².

CHD treatment

One of the most common treatments for CHD is coronary artery bypass grafting (CABG). CABG involves open-heart surgery where a section of a blood vessel is grafted from the aorta to the coronary artery to bypass the blocked section and improve the blood supply to the heart. Today this is a common procedure, however, it was only in 1967 that the basis of routine and safe coronary bypass surgery was formed. The number of CABG operations carried out annually in the UK is just under 20,000 although other interventions such as angioplasty are much higher.

Quality of life following a heart attack or heart surgery will depend on the severity of the episode. Those who engage in good cardiac rehabilitation and lifestyle modification (diet, weight control, exercise, smoking cessation) can go on to enjoy a normal quality of life.

Underwriting implications

As the surgical techniques for CABG have evolved, so too has the assessment of the risks posed by CABG procedures. It was once believed that CABG merely alleviated the symptoms of coronary heart disease but didn’t necessarily improve life expectancy. Consequently, the underwriting of CABG risks tended to reflect that view. However, this has changed and terms will usually be available for most applicants who have undergone a CABG. Underwriters will segment risks according to the severity of the underlying coronary disease, including the number of affected arteries and the importance of those arteries.

The age of the applicant is also very important. The younger the age at which the procedure is carried out or history of a prior heart attack, the heavier any extra premium will be. Depending on current cardiac health and age, extra premiums in the order of 2.5 times normal at younger ages or even 1.5 times at older ages are possible. In order to obtain the best terms, underwriters will want to see the most up to date assessment of cardiac health. Terms are unlikely to be available for serious illness or disability cover.


Underwriting CHD certainly has its challenges, which is why it’s important to get familiar with the disease and its treatment to ensure the correct decisions are made.

Sources:
1. BHF UK Factsheet April 2019
2. JAMA Network, Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2596007