Wednesday, March 13, 2013

Want Cheaper Life Insurance? Have an Ablation!

When I see patient's with supraventricular tachycardia, we discuss the the various options for therapy: (a) conservative treatment, (b) medical treatment, or (c) catheter ablation therapy for their arrhythmia.  More often than not, patients elect to have catheter ablation of their arrhythmia because of the procedure's proven track record for success, safety, and the need to avoid long-term medical therapy to suppress the arrhythmia.

But in adults, the mortality of supraventricular tachycardia is actually quite low.  Also, there are a group of patients who find they're not too bothered by the arrhythmia, or it's self-limited, or it's well-controlled with a minimal amount of medication.  For these patients, an invasive ablation procedure seems excessive, so they avoid it.

But now, it seems, there's another reason patient's might want to have a catheter ablation of their supraventricular tachycardia.  A patient recently brought us a letter they received after they inquired about a recent premium hike they noticed from their life insurance company:
"Dear Ms. Frigamafratz (not her read name):

Thank you for your inquiry regarding the change in premium.  The original premium estimate was given, as is customary, in the absence of all known medical history.  With the information now available from your verbal responses and physician records, an updated current premium quote is now provided. USAA strives to insure every member at competitive premiums which fairly reflect risk.

Careful review of your medical history reveals recurrent problems with supraventricular tachycardia.  In some cases, lesser premiums are permissible for members who have successfully undergone the ablation procedures to remedy the problem, and subsequently remain without manifestations for at least six months.  Alternatively, we can consider a more favorable premium for individuals with supraventricular tachycardia who have had a thorough cardiac evaluation and documented spontaneous remission of the problem for at least five years.  The latter is not an endorsement nor recommendation of any medical treatment, but gives insight to elements of risk approval used to determine your life insurance premium quote.  You are encouraged to provide any new medical information to support a better rate and we will be happy to review."
I should be quick to mention that the recommendations or information given on this blog are not an endorsement nor recommendation of any medical treatment either, but at least you now know one more advantage to catheter ablation for supraventricular tachycardias: the potential for cheaper life insurance premiums!

But I have to wonder, is a adult patient with symptomatic paroxysmal supraventricular tachycardia really going to have reduced mortality if they undergo a catheter ablation procedure?  While mortality of SVT ablation has been quoted as low as 0.1%, that low mortality comes with an adverse event rate of 2.9%.  I am unaware of a direct comparison of conservative or medical therapy mortality to catheter ablation, but I suspect with such a low incidence of mortality, such a mortality trial will never be performed because of the large number of patients required to show a statistical difference in mortality between the treatment arms.

So I wonder where the data are that support USAA's higher life insurance premium rate for adults?


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