Coronary Artery Disease – Diagnosing & Underwriting the Risk (Part 2)
In part 1 of this 2-part ONE Idea series on coronary artery disease (CAD), we talked about underwriting the risk factors of coronary artery disease such as weight, blood pressure, family history, and diet. We also touched on some of the tests that help to diagnose the extent of CAD and the available treatment options. (Part 1 of the series) Your proficiency in Field Underwriting is critical. It will help you ask the right questions, save you the frustration of going back to your client for more information, and get your case into formal underwriting with the right carrier much earlier!
This week’s ONE Idea will provide a quick recap on coronary artery disease and test your knowledge with some questions and answers that may improve your field underwriting knowledge.
Coronary Artery Disease is present when blockages in blood flow exist within the coronary arteries. Cholesterol deposits (plaques) are usually the culprit creating these blockages. Blockages come in varying degrees and build up over the years. A 50% blockage is certainly more concerning than a 20% blockage. Generally speaking, once coronary artery disease (cholesterol plaques) starts forming, you cannot get rid of it, but diet, exercise, and medications can certainly slow down or even halt its progression.
Quiz Question #1: Does a Coronary Calcium Score of 100 Versus 600 Make a Better or Worse Cardiac Risk for CAD?
Any score above zero suggests that there is some degree of coronary artery disease. Following is the breakdown of scores relating to risk:
- A score of 100 or lower would suggest “mild proof” of CAD;
- Up to 400 suggests “moderate proof”; and
- Above 400 suggests “strong proof” of the disease.
The higher the score, the more likely the presence of coronary artery disease and a factor for treatment decisions moving forward.
A calcium score test (determined with a CT scan) does not reveal whether the arteries are blocked or not. The only way to determine that fact is with a Cardiac Catheterization (still the gold standard of CAD investigation) or a CT Angiogram.
Additional note: Calcium deposits and cholesterol plaques can develop inside the artery and disrupt the flow of blood AND/OR it can be deposited inside the artery walls where it WILL NOT obstruct the flow of blood. You can have a high coronary calcium score leading you to believe you are at high risk of having CAD but a cardiac catheterization could potentially show completely normal blood flow through the artery. A new test, CT Angiogram, is much less invasive than cardiac catheterization in determining whether significant blockages exist in the artery itself and not just deposits within the arterial walls.
Quiz Question #2: Does an Abnormal Resting EKG or Abnormal Stress EKG Indicate Coronary Artery Disease?
A Resting EKG (electrocardiogram) is nothing more than a screening test. If the EKG is “normal,” that does not mean you DO NOT have coronary artery disease. And just the same, an Abnormal Resting EKG does NOT indicate that you DO have coronary artery disease. The Resting EKG has become “unreliable” as an underwriting tool for life insurance companies. As a result, most carriers now utilize a simple blood test: NT-proBNP. (See a previous ONE Idea – Understanding the Role of NT-proBNP in Medical Underwriting).
An abnormal Resting EKG or Abnormal NT-proBNP will likely lead to stress testing, which can be a treadmill EKG tracing, a more involved Stress Perfusion (radioactive dye under high heart rate), or Stress Echocardiogram that checks your heart muscle activity under a high heart rate (stress).
If the stress testing results are “positive,” it may indicate that coronary artery disease is present and further investigation is warranted to determine the degree of the disease and treatment options. A whole host of excellent diagnostic tools exist that are non-invasive (non-surgical), can confirm disease, and offer the cardiologist the best treatment options.
Quiz Question #3: What are the Signs and Symptoms of Coronary Artery Disease?
Chest pain – crushing or nonexistent. We’ve all heard the term Silent MI (Silent Myocardial Infarction with no signs or symptoms). Angina is the term for cardiac-related chest pain usually associated with coronary artery disease. Blocked arteries create a lack of oxygen to the heart muscle, so the muscle “aches” and you feel pain. However, the nerve plexus for the heart muscle is also aligned with the left arm and the jaw so angina symptoms can manifest themselves in jaw pain or left arm pain. Any chest discomfort that is associated with left arm pain or jaw pain should be considered a cardiac concern until proven otherwise, especially if you have coronary artery disease risk factors.
Shortness of breath, windedness, unusual fatigue, and dizziness can all be signs that something may be affecting your heart function and should be investigated by your doctor or even at the Emergency Room.
Quiz Question #4: Is Cardiac Bypass Surgery Better than Coronary Artery Stents?
Once significant coronary artery disease is found and you present with symptoms as noted above, it is probably time for definitive treatment through invasive procedures like cardiac bypass surgery or an angioplasty with a stent(s). There are very good mortality reasons for one procedure over the other but treatment depends upon the severity of CAD and the doctor’s suggested treatment.
Angioplasty with drug eluting stents (deter blood clots) is being utilized more often today as the treatment is less invasive than open-heart chest surgery, requires shorter recovery time, and offers less complications. Cardiac catheters have become much more refined, and stents have also been improved over the past few years. As for the long-term mortality after either procedure, it is pretty much a dead heat (slight pun intended).
Conclusion
Coronary Artery Disease accounts for over 600,000 deaths a year and remains the leading cause of mortality in the United States. However, being diagnosed with CAD is not a death sentence by itself as lifestyle and health style changes, modern medications, and advanced medical procedures are allowing for long and productive lives.
Simply having the diagnosis of coronary artery disease does not make you uninsurable but the degree of coronary artery disease – when available – will allow the underwriters to better categorize the RISK. With copies of your clients’ medical records and test results, AgencyONE can underwrite these risks for the life insurance protections they desire.
Quiz Final Question: Can a Person with a Known Diagnosis of Coronary Artery Disease in their Medical Record get STANDARD or BETTER Life Insurance Protection?
The answer is YES! The AgencyONE Underwriting team has proven EXPERTISE in case evaluation, carrier solutions, and carrier placement.
Please contact the AgencyONE Underwriting team at 301.803.7500 for more information or to discuss a case.
