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Masterclass - Coronary heart disease
For advisers only
Competitor analysis correct at time of publishing
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Agenda
1. The role of the heart
2. Anatomy of a heart attack
3. How critical illness defines a heart attack
4. How VitalityLife defines a heart attack
5. Underwriting considerations
6. VitalityLife - unrivalled cover for conditions affecting the cardiovascular system
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The role of the heart
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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
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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
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Impact of cardiovascular disease
Death by cause in men under 75 for the UK in 2010
•
Accounting for just under a third of deaths, cardiovascular disease (CVD) is one of the biggest killers in the UK
•
Just under 50% of deaths due to CVD are from coronary heart disease. By itself, CHD is the biggest single cause of death.
•
CVD is one of the main causes of premature death, accounting for 26% of premature deaths in men and 18% of
premature deaths in women
Source: British Health Foundation, Cardiovascular Disease Statistics 2014 (G608/1214/CHA)
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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: British Heart Foundation, Trends in Coronary Heart Disease 1961 -2011 (published 2011) - (M129)
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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
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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
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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>0.2ng/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
-
Angina without myocardial infarction
Source: ABI Statement of Best Practice December 2014
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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 in 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]).
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How VitalityLife defines a heart attack
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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 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 pay ALL heart attack claims
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Competitor overview
Highlighting VitalityLife’s unique cover for heart attack
Provider
Definition name
Payout %
Typical clinical
symptoms
VitalityLife
Heart Attack
25%
×
n/a
X
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

AIG
Heart Attack of specified severity
100%
×
Yes

Bright Grey
Heart Attack of specified severity
100%
×
Yes

Friends Life
Heart Attack of specified severity
100%
×
Yes

L&G
Heart Attack of specified severity
100%
×
Yes

LV=
Heart Attack of specified severity
100%
×
Yes

Scottish Provident
Heart Attack of specified severity
100%

Yes

Heart Attack
100%
×
Yes
X
Heart Attack of specified severity
100%
×
1.0ng/ml

VitalityLife
Old Mutual
Zurich
Troponin rise New ECG
required
changes
Source: VitalityLife analysis
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Why VitalityLife 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 we are 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 cover ALL heart attacks
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Underwriting considerations
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Underwriting considerations
Risk factors of CHD
•
•
•
•
•
•
•
•
•
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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
44 year old male-angina first
diagnosed 8 months ago, now stable.
No surgery pending
Postpone for 4 months then will
require TGPR
65 year old female.
Heart attack in 2010 with single vessel bypass at the time.
Has been well since but still smoking 10 cigarettes per day
A loading in the region of 50100% will be applied
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
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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Comparing the market
VitalityLife – unrivalled cover for multiple sclerosis unrivalled cover for conditions affecting the cardiovascular system
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Unique cover
Severity
Unique to VitlaityLife
Congestive heart failure
Severe peripheral vascular disease
Severe vascular disease affecting multiple systems
Heart Attack - resulting in reduced ejection fraction
Heart Attack of specified severity
Heart Attack
Heart and artery
A
A
A
A-B
C
D



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
Endovascular repair of an aortic aneurysm
Heart valve replacement or repair
Surgical repair of a structural lesion of the heart
Balloon valvuloplasty
Femoral artery aneurysm repair
Iliac artery aneurysm repair
Pericardectomy
Surgery to correct carotid artery stenosis
Angioplasty
Angioplasty to correct carotid artery stenosis
Cardioversion for cardiac arrhythmia
Emergency intravenous anti-arrhythmic therapy for ventricular tachycardia or
fibrillation
Infective endocarditis (restricted to one payment only).
Keyhole coronary artery bypass surgery
Permanent defibrillator insertion
Permanent pacemaker insertion
Surgery for cardiac arrhythmia
Surgical repair of an atrial or ventricular septal defect
A-B
B
B
B-C
D
D
D
E
E
E
E
E
F
F
F

F
F
F
F
F
F
F










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