AFib and Life Insurance – New Guidelines, Lower Rates?

Do New Guidelines Mean Lower Rates?

Clients often find us looking for life insurance with AFib. It makes sense, since it is one of the most common heart conditions that we get life insurance approvals for every day.

Recently leading physicians threw the book out on the guidelines for treatment for Atrial Fibrillation. What does this mean for you, as it relates to getting the best life insurance rates for AFib?

The rules have changed regarding your treatments, and life insurance companies are usually slow to react to these changes. Therefore, it is more important now than ever to work with one of our underwriting experts to guarantee the lowest life insurance rates for your heart condition.

Start by getting your free quote and let’s dive into these changes.

As stated by the medical authors, they started with a blank slate and completely re-wrote very important pieces.  In the following video, Dr. Hugh G. Calkins, MD, FHRS, explains what’s new in the guidelines.  If you’re suffering from Atrial Fibrillation, this is worth watching.  Dr. Calkins is not only one of the authors of the new guidelines, but he is a Fellow of the American Heart Association, the HRS, and the American College of Cardiology.

Here are some of the changes and how they relate to life insurance underwriting:

First and most significant, the new treatment guidelines place a higher emphasis on the CHA2DS2-VASc or CHADS-VASC score versus the old CHADS2 score. 

The research is statistically significant as this new scoring model for stroke risk features many new factors.  Take a look here with your doctor and score yourself. Congestive heart failure, hypertension, your age, diabetes, prior stroke, TIA, and your sex (male or female) all play a part in your risk for stroke; therefore this new scoring model counts them all to get a better picture and diagnosis.

What does this mean for underwriting the best life insurance rates?

More underwriters will likely scrutinize the CHADS-VAS scores in their decisions to approve/deny since it contains an entire encyclopedia of risk factors.  We would anticipate these findings from your cardiologist to be at the top of an underwriter’s wish list, especially for life insurance coverage over $1 Million.

Anticoagulation drugs are being prescribed now with a CHADS-VASC score as low as one.

What this means, practically, is more patients will be prescribed anticoagulants earlier (such as Warfarin, Coumadin, Xarelto, Dabigatran and Rivaroxaban) as a standard treatment for AFib.  This is especially true for patients suffering from other health complications, like high blood pressure or problems with the thyroid.

What does this mean for underwriting the best life insurance rates?

More prescriptions of anticoags will increase the data points on how they affect life expectancy.  Our guess is the prevalence of these drugs will only increase life expectancy, and that’s good news for life insurance applicants with atrial fibrillation.

Some of these drugs are familiar to underwriters (like Warfarin), whereas some of the alternative anticoagulants have not made their “medications of concern” list … yet.  Combinations of these drugs might also trigger an automatic decline of life insurance cases, so it’s important to work with an underwriting expert in lieu of the new treatment guidelines.

Aspirin for stroke prevention is falling out of favor.

Dr. Calkins says “the data isn’t there” to support Aspirin reducing stroke risk for patients that have AFib.  He doesn’t even recommend it to patients with a CHADS-VASC score of 1 or higher, saying that he prefers to “err on the side of anticoagulation.”

What does this mean for underwriting the best life insurance rates?

Not much really since aspirin was never scrutinized as a medication.  I just think it’s interesting since Aspirin has long been thought to provide benefits for heart and circulatory health.  Science may reverse its stance on this issue.

Rhythm control intervention is suggested earlier than before.

New guidelines state rhythm control should be pursued early to prevent atrial remodeling or the physical, structural changing of the heart muscle due to AFib.  Doctors were advised earlier to take a “wait and see” approach for mild AFib, however the new guidelines advise a different route of treatment.  By pursuing these heart rhythm control strategies sooner, it leaves a patient with more options down the road for treatment (like catheter ablation).

What does this mean for underwriting the best life insurance rates?

Dr. Calkins prefers an antiarrhythmic drug intervention first, so that probably means more scripts for drugs like Amiodarone (Cordarone, Pacerone), Bepridil Hydrochloride (Vascor), Disopyramide (Norpace),Dofetilide (Tikosyn), Dronedarone (Multaq), Flecainide (Tambocor),Ibutilide (Corvert), Lidocaine (Xylocaine), Procainamide (Procan, Procanbid), Propafenone (Rythmol), Propranolol (Inderal), Sotalol (Betapace), and Tocainide (Tonocarid).

The good news is that most of these medications do not trigger an automatic decline for the best life insurance rates, and their prescription shows proof of a positive maintenance plan to control your atrial fibrillation.

You need only one occurrence of AFib to be considered an Atrial Fibrillation sufferer.

The prior guidelines (2006) stated a patient needed a recurring incidence of AFib to be considered a patient.  The new guidelines change that; one occurrence of AF is all one needs to be considered for further treatment of AFib.

What does this mean for underwriting the best life insurance rates?

It depends on the insurance company. We can expect that AFib, by name, will make it onto new life insurance applications when the companies update them. Most questions relating to AF simply ask about “irregular heartbeat”.

Since only one diagnosis of AFib is enough to be automatically declined for most life insurance, it is important to work with an underwriting expert who can place you with a company that views atrial fibrillation risk more favorably.

For a select few insurance companies, a diagnosis of AFib can still be approved at good rates with proper proof of maintenance.  These companies do not advertise though, so if you are not working with one of our underwriting experts specializing in heart conditions, you would never know about them.

How long must the arrhythmic episode last to be considered atrial fibrillation?

Good question, because the new guidelines leave the definition up to your cardiologist .  Is it one minute?  Two minutes?  Five?  The guidelines are intentionally silent here, though Dr. Calkins still thinks 30 seconds or more should be the standard.

What does this mean for underwriting the best life insurance rates?

For the slim minority of patients right on the bubble–having an arrhythmic heart episode that was very short–doctors might not have diagnosed AFib in the past.  Now, these patients with an AFib episode of less than a minute would probably receive the diagnosis and start treatment.  Though it means checking off another box in the health questions section of a life insurance application, earlier diagnosis ultimately leads to longer lives.

The classification of atrial fibrillation based on duration was defined.

If a sufferer has an episode lasting less than 7 days, AFib is deemed paroxysmal.  Usually these episodes last less than 24 hours. 7 days to 1 year’s worth of duration is categorized as persistent.  Persistent AF sufferers can still benefit from cardioversion. More than a year is categorized as long standing persistent, and the patient does not respond to cardioversion.

For these patients, an irregular heartbeat seems to be a constant companion.  The classification of “permanent” AFib was removed to give patients more treatment options.  It was replaced by “long standing persistent”, since if there has been no significant structural change to the heart, patients could still seek options of rhythm control.

What does this mean for underwriting the best life insurance rates?

These questions are posed on the additional questionnaires with the life insurance application required for any condition of the heart.  We would expect underwriting guidelines fall in line with these new, specific definitions of AFib based on duration, and the category of “permanent” AFib will be dropped from the underwriting lexicon.

Conclusion:

It is more important now than ever to get an underwriting expert involved to help you get the best life insurance rates considering these changes to the atrial fibrillation guidelines.  CHADS-VASC scores will be leaned on heavily in the future approval of these cases, and the earlier and increased prescription of novel oral anticoagulants could have a positive effect on longer life expectancy for patients suffering with AFib.  

That’s really the goal, isn’t it?  Longer, happier healthier lives?  

Longer life expectancy also means easier approvals and lower premiums, so in the end these new guidelines should be great news to AF patients.