Coronary artery disease, stents and bypass

Where this sits

Coronary artery disease means the arteries supplying the heart muscle have narrowed. It covers a wide range, from a single narrowing found during investigation of chest pain through to extensive disease requiring bypass surgery.

That range is the reason the underwriting outcomes vary so much. A person who had one stent placed five years ago, has had no symptoms since and whose heart function is normal presents a fundamentally different file from someone with disease in three vessels and reduced pumping function. The diagnosis is the same phrase; the assessment is not.

Offers are made regularly in this category. Ratings are the norm rather than the exception, and their size depends on the specifics below.

The extent of the disease

How many vessels are involved, and how severely, is the first thing an underwriter establishes.

Single-vessel disease successfully treated is the most favourable version. Two-vessel disease attracts more attention. Disease across three vessels, or involving the left main artery, is assessed most cautiously, because more of the heart muscle depends on the affected supply.

This information comes from your angiogram report and your cardiologist’s records rather than from anything you can summarize on an application, which is why obtaining an attending physician statement is standard in these files.

What was done, and when

Angioplasty with a stent is the most common intervention. Underwriters note how many were placed, where, and whether any have needed repeat treatment. A stent that has stayed open is unremarkable; repeat narrowing at the same site is a different signal.

Bypass surgery is generally read as indicating more extensive disease, since it is usually undertaken when several vessels are involved. That said, a successful bypass with good function afterwards and no ongoing symptoms can be assessed reasonably well, sometimes better than untreated multi-vessel disease.

Medical management alone, where narrowing was found but no procedure was performed, is assessed on the severity and on how the symptoms have behaved.

Timing matters in every case. Most insurers want a defined period to pass after a procedure before assessing, because the early months are when complications appear. Applying a few weeks after a stent generally produces a postponement, which is not a decline and simply means the file is being assessed too early.

Ejection fraction

This is one of the most heavily weighted numbers in cardiac underwriting.

Ejection fraction is the proportion of blood the left ventricle pushes out with each beat, measured by echocardiogram or similar imaging. It indicates how well the heart is actually pumping, which matters more to an insurer than the anatomy of the arteries.

A normal ejection fraction after treatment is a strong point in a file. A reduced one shifts the assessment considerably, because it indicates the heart muscle has been affected, and it moves the file toward heart failure territory, which is assessed on its own terms.

If you have had an echocardiogram, the result is in your records. Knowing roughly what it showed is useful when you apply.

Symptoms since

Underwriters give heavy weight to what has happened since treatment.

Someone with no chest pain, no breathlessness on exertion, and no further hospital visits over several years has a record that speaks for itself. Recurrent angina, reduced exercise tolerance, or repeat admissions indicate the condition is active rather than settled.

Stress test results and follow-up imaging support this picture, and they are among the most useful documents in a cardiac file.

What accompanies it

Coronary disease rarely stands alone, and the accompanying factors matter a great deal here.

Nicotine use alongside coronary artery disease is the combination underwriters treat most seriously, because continued smoking after a cardiac event materially changes the outlook. Someone who stopped at the time of their event and has stayed stopped is in a much stronger position, and the timing is usually documented.

Diabetes alongside coronary disease is also significant, because the two interact. Blood pressure and cholesterol are assessed as part of the overall management picture rather than as separate items.

Completing cardiac rehabilitation and attending regular follow-up both appear in records, and both read favourably.

If full underwriting does not produce an offer

The alternatives exist and are worth using rather than going without.

Simplified issue products ask a short set of questions, several of which concern recent cardiac events, so timing determines whether they are available. Guaranteed issue asks nothing about health, at a smaller amount and with a waiting period at the start.

Before going to either, apply fully underwritten. Cardiac underwriting varies widely between insurers, and an offer that one company will not make another may.

Applying well

Wait until the period after any procedure has passed, and ask what that period is before applying rather than after being postponed.

Bring the specifics: what was found, what was done and when, your most recent ejection fraction if you know it, your cardiologist’s name, and an honest account of any symptoms since.

Nothing on this page is advice about managing heart disease. Your cardiologist and your family doctor own that, and the reasons for following their guidance have nothing to do with an insurance application.