What is a-fib (atrial fibrillation)? Basically, AF is an abnormal rhythm of the heart that is manifested as a rapid, irregular pulse. Some people who have AF are unaware of their condition, but more often they complain of palpitations (rapid, fluttering or pounding). Symptoms of shortness of breath, chest pain and decreased exercise tolerance may indicate more extensive cardiac disease.
The most common arrhythmia, or abnormal heart rhythm, in the United States is atrial fibrillation and it affects 2.7 million Americans. Approximately 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib. In 10 to 15 percent of these cases, the disease occurs in the absence of structural heart disease.
How is it evaluated? A typical evaluation should include an echocardiogram and sometimes, a stress test if there are symptoms or risk factors that suggest coronary artery disease.
Treatment depends on the individual. Those with AF and an otherwise normal heart may just need medicine when they feel their palpitations. However, older individuals with underlying heart disease often need chronic medicines, including a blood thinner to decrease the risk of stroke.
Pulmonary vein ablation, a catheter-based cardiology procedure, is being used more frequently to prevent recurrences of AF. Its long-term success rate approaches 80%, sometimes after multiple procedures in people with AF and normal hearts.
Shirley, 35, has a history of palpitations. Her doctor determined that these were due to atrial fibrillation (AF), an abnormal rhythm of the heart. Shirley’s atrial fibrillation was caused by hyperthyroidism. Once her thyroid disease was treated, her palpitations disappeared and she has been fine ever since.
Outcome: Shirley could be rated Preferred for Life Insurance if she otherwise qualifies.
Jack, 40, has a five-year history of on-again, off-again palpitations. A heart monitoring test determined that these were due to brief episodes of AF. Echocardiogram and stress testing showed that his heart was structurally normal. When Jack feels the palpitations, he takes metoprolol, a medication to slow the heart. This happens no more than twice a year.
Outcome: Jack would be considered a Standard risk for life.
Underwriting AF for life is a challenge given all the variables involved. Those people with rare episodes of atrial fibrillation can be Standard or even Preferred for Life Insurance, depending on the frequency and last episode of AF and the need for medication. Those requiring constant medicines for their AF will be offered a mild to moderate rating with credits available for stability and evidence of an otherwise normal heart.
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