Broken hearts in underwriting

The broken-heart syndrome is new and rare diagnosis that risk assessors are now encountering with increasing frequency in the life insurance industry. The good news before Valentine’s Day: What looks like a heart attack, usually turns out to be harmless a few days later.

Medical research discovers new diseases regularly. One such example is takotsubo cardiomyopathy – also known as broken-heart syndrome. A typical case: Upon learning that her husband has died in an accident, a 60-year-old woman collapses with chest pains. All indicators point to a heart attack, which is also confirmed by the ECG and laboratory values. Even the echocardiography shows an initial severe impairment in the functioning of the left ventricle. And then the surprise: A few days later, the woman's pulse returns to normal, ruling out coronary heart disease.

Only a few years ago, in such cases, patients were discharged with a diagnosis of "acute coronary syndrome, unidentified cause". Today, with increasing frequency, risk assessors find the diagnosis of takotsubo cardiomyopathy in the files of applicants who have had similar attacks. Tako tsubo is the term for a traditional ceramic clay pot that is used by Japanese fishermen as an octopus trap. In 1991, when Asian researchers examined acutely ailing patients with methods that called for descriptive images, they were the first to discover a characteristic deformation of the left ventricle reminiscent of the balloon-like shape of the octopus trap. In 2006, takotsubo was added to the list of classified cardiomyopathies of the American Heart Association.

"Today we know that takotsubo is a temporary disorder. It is triggered by emotional stress following extreme, distressing events such as the death of a loved one or a heated quarrel", Andreas Armuss, Senior Medical Consultant in Life explains. Notably: Some 90% of the cases are women aged 60 to 75. This means that a good 7% of all acute coronary syndromes in women that are unidentified to date are attributable to takotsubo. In the overall population the rate is likely to be 1 to 2%. Broken-heart syndrome is therefore highly relevant for life insurance, particularly in view of the fact that the number of diagnosed patients is likely to increase as we find out more about the condition.

The good news is that, contrary to patients who suffer myocardial infarction, takotsubo patients usually recover completely and a recurrence of the symptoms is rare. This is the reason for the generally excellent risk prognoses, which means that the applicants are insurable with no or with only negligible premium loadings. "To enable us to make an evidence-based assessment in individual cases, we have established all data and studies on broken-heart syndrome available worldwide and compiled a new rating page in MIRA", says Armuss. This was made possible by the extensive experience of the Life unit in assessing "new" and rare diseases.