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Masterclass - Coronary Heart Disease
Competitor analysis correct at time of publishing
For advisers only
July 2014
Agenda
1. The role of the heart
2. Anatomy of a heart attack
3. How critical illness defines a heart attack
4. How PruProtect defines a heart attack
5. Underwriting considerations
6. PruProtect - unrivalled cover for conditions affecting the cardiovascular system
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The role of the heart
The heart
•
A normal heart beats 100,000 times a day or
3 billion times in an average lifetime
•
Each day it pumps 5,000 gallons of life sustaining
blood through a 60,000 mile network of vessels
•
Blood takes approximately 20 seconds to circulate
throughout the entire vascular system
Source: https://www.bhf.org.uk/heart-health/how-your-heart-works.aspx 2014
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Anatomy of a heart attack
Anatomy of a Heart Attack?
1.
A coronary artery becomes narrowed
2.
It cannot deliver enough oxygen-containing
blood to the heart muscle
3.
The inside lining of the narrowed artery
cracks, a blood clot may form over the
cracks
4.
This makes the artery even narrower and
can quickly block off the artery
5.
If the artery is blocked for more than a few
minutes, the muscle cells in the heart may
become permanently damaged
Often, the amount of muscle damage is small
and, once the heart attack is over, there is
enough good muscle left for the heart to carry
on its work satisfactorily
6
Impact of cardiovascular disease
Death by cause in men under 75, UK 2010
•
Accounting for over a third of deaths,
cardiovascular disease (CVD) is by far the
biggest killer
•
Just under 50% of deaths due to CVD are from
coronary heart disease
•
CVD is one of the main causes of premature
death, accounting for 30% of premature
deaths in men and 22% of premature deaths in
women
Source: http://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=508b8b911301-4ad7-bc7e-7f413877548b&version=-1&title=Coronary+Heart+Disease+Statistics+2012+&resource=G608- 2012
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Medical and demographic trends
How heart disease has changed
Over 17,000% increase in life saving
prescriptions since CIC was launched
Heart disease death rates halved
since 1961
Source: http://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=508b8b911301-4ad7-bc7e-7f413877548b&version=-1&title=Coronary+Heart+Disease+Statistics+2012+&resource=G608 - 2012
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Preventing and treating a heart attack
Angioplasty
Angioplasty can help to relieve angina
symptoms and is also used as an
emergency treatment for people
who've had a heart attack
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Angioplasty key facts
The importance of our unique definition
c 5 x the number of
Angioplasty to CABG
Most angioplasty’s are
performed on a single
vessel
Most people who undergo
angioplasty haven’t suffered
a heart attack
Angioplasty (Coronary) or PTCA (Percutaneous Transluminal Coronary Angioplasty) –
Severity F
PTCA or other percutaneous coronary artery procedures performed by a Consultant
Cardiologist to dilate and treat a coronary artery stenosis. The procedure may or may not involve
the use of a stent
Dr Rod Stables, The Cardiothoracic Centre, accessed 2014
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How critical illness defines a heart attack
ABI definition
Pre 2006
Heart attack
The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all
of the following evidence of acute myocardial infarction:
•
typical chest pain;
•
new characteristic electrocardiographic changes;
•
the characteristic rise of cardiac enzymes, troponins or other biochemical markers; where
all of the above shows a definite acute myocardial infarction
Other acute coronary syndromes, including but not limited to angina, are not covered under this
definition
12
Industry definition
Heart Attack of specified severity
•
Death of heart muscle, due to inadequate blood supply, that has resulted in the following
evidence of acute myocardial infarction:
•
Typical clinical symptoms (for example, characteristic chest pain)
•
New characteristic electrocardiographic changes
•
The characteristic rise in cardiac enzymes or troponins recorded at the following
levels or higher;
-
Troponin T>1.0ng/ml
-
Accu Tnl > 0.5ng/ml or equivalent threshold with other Troponin I methods
•
The evidence must show a definite acute myocardial infarction
•
For the above definition, the following are not covered:
-
Other acute coronary syndromes including but not limited to angina
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Typical clinical symptoms
Not every person suffering a heart attack will have obvious symptoms
•
•
•
•
•
The symptoms of a heart attack vary from one person to another
They may feel tightness or pain in the chest
For some people, the pain or tightness is severe
Others may feel nothing more than a mild discomfort
They may feel
– light-headed or dizzy
– short of breath
– nauseous
– vomiting
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New characteristic ECG changes
“not all heart attacks can be detected by ECG”
Source: http://www.patient.co.uk/health/electrocardiogram-ecg |
http://www.thrombosisadviser.com/en/acs/a-leading-cause-of-mortality/ - 2014
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Characteristic rise on cardiac enzymes/troponins
•
The current ABI levels were set in 2006
•
Since then troponin assays have become significantly more sensitive , with some
now measuring as little as a few picograms (a picogram being 1/1000th of a
nanogram [ng]).
•
Current clinical practice suggests a troponin T level of 0.1ng/ml or less as the
criteria for diagnosis of a probable MI, well below the current ABI level of 1ng/ml
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How PruProtect defines a heart attack
Our definition
Heart Attack of specified severity
Death of heart muscle, due to inadequate blood supply, that has resulted in the following
evidence of acute myocardial infarction:
•
•
New characteristic electrocardiographic changes, and
The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or
higher;
- Troponin T > 0.5 ng/ml
- AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods
The evidence must show a definite acute myocardial infarction
For the above definition, the following are not covered:
• Other acute coronary syndromes including but not limited to angina
Payable at severity C – 50% to a maximum of £1,500,000
We will now pay more heart attack claims
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Our unique definition
Heart Attack
Death of heart muscle, due to inadequate blood supply that has resulted in the
following:
Definite Diagnosis of an acute Myocardial Infarction by a consultant cardiologist,
which is supported by current medical reports, tests and investigations, as defined by
the recognised international standard* prevailing at the time of claim
For the above definition, the following are not covered:
• Other acute coronary syndromes including but not limited to unstable angina.
• Myocardial Infarctions that meet the international standard that occurred before cover
commenced
*(International standard defined by the European Society of Cardiology or the
universal standard definition of Myocardial Infarction)
Payable at severity D – 25% to a maximum of £750,000
We will now pay ALL heart attack claims
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Competitor overview
Highlighting PruProtect’s unique cover for heart attack
Definition name
Payout %
Typical clinical
symptoms
PruProtect
Heart Attack
25%
×
n/a
PruProtect
Heart Attack of Specified Severity
50%
(100% booster)
×
0.5ng/ml

Aegon
Heart Attack of specified severity
100%
×
1.0ng/ml

Aviva
Heart Attack of specified severity
100%
×
yes

Ageas
Heart Attack of specified severity
100%
×
yes

Bright Grey
Heart Attack of specified severity
100%
×
1.0ng/ml

Friends Life
Heart Attack of specified severity
100%
×
yes

L&G
Heart Attack of specified severity
100%
×
1.0ng/ml

LV=
Heart Attack of specified severity
100%
×
yes

Scottish Provident
Heart Attack of specified severity
100%

yes

Skandia
Heart Attack of specified severity
100%
×
1.0ng/ml

Zurich
Heart Attack of specified severity
100%
×
1.0ng/ml

Provider
Troponin rise
New ECG changes
required
×
Source: PruProtect Analysis
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Why PruProtect for Heart Attack
•
We will pay 25% on diagnosis of ALL art attacks
– We do not require characteristic ECG changes
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Heart attack
What this all means
The Need
What are we doing?
Traditional cover requires
a heart attack to be a specified
severity
Covering diagnosis of
All heart attacks
It’s the UK’s biggest killer
Most
consumers
expect a heart attack to
be covered no matter
how severe
45%
More likely to
payout
compared to
industry
standard
definitions
We now cover ALL heart attacks
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Underwriting considerations
Underwriting considerations
Risk factors of CHD
•
•
•
•
•
•
•
•
•
•
Smoking
High blood pressure
High blood cholesterol
Diabetes -Decline
Being physically inactive
Being overweight or obese
Family history of heart disease
Ethnic background
Gender - men are more likely to develop CHD at an earlier age than women.
Age - the older you are, the more likely you are to develop CHD.
•
It is more acceptable for an older person to have a heart attack than a younger person and
our ratings reflect this:
- A 46 year old with heart attack +- 200%
- A 66 year old with heart attack +- 125%
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Underwriting considerations
What does the underwriter need before making a decision?
•
•
•
•
TGPR to include sight of all investigations and surgical procedures
Date of onset and date of most recent symptoms
Has there been more than one heart attack (increase rating if 2, but decline if more)
Other risk factors present (as previously mentioned)
•
Better risk
Older age, N/S, BP and Lipids all normal, single event, normal BMI, healthy lifestyle
•
Poorer risk
Younger age, smoking, obese, more than one event, questionable lifestyle
•
Definite declines
Combination of CHD and diabetes, client < age 40, >30 cigs pd, > 2 heart attacks
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Underwriting considerations
Some case studies
1. 44 year old male-angina first diagnosed 8 months ago, now stable. No surgery pending
Postpone for 4 months then will require TGPR
2. 65 year old female. Heart attack in 2010 with single vessel bypass at the time. Has been well
since but still smoking 10 cigarattes per day
A loading in the region of 50-100% will be applied
3. 55 year old male. Had a heart attack in 2009 and then another in 2011 followed by a 2 vessel
stent and has been well since
A loading of 200-250% will be applied
4. 32 year old with a poor FH of CAD and who has had been suffering from angina since age
31. Maybe going in for an angiogram in next few months
Decline
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PruProtect - unrivalled cover for conditions affecting
the cardiovascular system
Unique cover
Heart and artery
Severity
Unique to PruProtect
Congestive heart failure
A

Severe peripheral vascular disease
A

Severe vascular disease affecting multiple systems
A

Heart Attack - resulting in reduced ejection fraction
A-B
Heart Attack of specified severity
C
Heart Attack
D

A-B

Any other cardiac condition resulting in a reduced ejection fraction
Aorta graft surgery
Cardiomyopathy resulting in a reduced ejection fraction
Coronary artery by-pass grafts
B
B
B-C

Endovascular repair of an aortic aneurysm
D
Heart valve replacement or repair
D
Surgical repair of a structural lesion of the heart
D
Balloon valvuloplasty
E

Femoral artery aneurysm repair
E

Iliac artery aneurysm repair
E

Pericardectomy
E

Surgery to correct carotid artery stenosis
E
Angioplasty
F
Angioplasty to correct carotid artery stenosis
F
Cardioversion for cardiac arrhythmia
F

Emergency intravenous anti-arrhythmic therapy for ventricular tachycardia or fibrillation
F

Infective endocarditis (restricted to one payment only).
F

Keyhole coronary artery bypass surgery
F
Permanent defibrillator insertion
F
Permanent pacemaker insertion
F

Surgery for cardiac arrhythmia
F

Surgical repair of an atrial or ventricular septal defect
F

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