Why Data Drives Underwriting Assessments of Heart Valve Disorders
Mitral regurgitation, or mitral insufficiency, is the second most common form of valvular heart disease, after aortic stenosis. It’s a heart valve disorder that occurs when the mitral valve does not close properly during ventricular systole (contraction). It means that a back flow of some blood is allowed into the heart’s left atrium (regurgitation).
Mitral regurgitation (MR) has a similar prevalence in men and women. It seems to be on the increase, but that could be because of the greater availability of echocardiography resulting in more incidental findings of MR.
The most common cause of MR in the U.S. is mitral valve prolapse, with a greater risk of complication in men. Ischemic heart disease is the next most common cause. (Ischemic MR results from papillary muscle dysfunction, regional left ventricular dysfunction and global left ventricular dilation.)
Chronic MR is a slowly progressive disease that usually remains asymptomatic and stable for many years. It progresses more rapidly in patients with connective tissue disorders, such as Marfan syndrome. Age is also an important aspect in the risk selection of MR, because it is a progressive disorder - the earlier the onset of MR, the more time there is for progression. Therefore, younger ages may require a higher rating than older ages.
Not surprisingly, underwriting mitral valve regurgitation is a complex process that requires a good understanding of left heart anatomy and circulatory function. Underwriting chronic MR calls for the use of clinical criteria and measurable data, to assess the severity of the valve disorder. If many echocardiogram studies have been done over many years, the data results may show a favorable pattern of stability or may indicate a progression of severity. Conversely, if the number and frequency of studies are limited, and the most recent evaluation of heart function is from many years ago, a current estimate of severity can make assessment a challenge.
In my recent article published by On The Risk (the Academy of Life Underwriting journal) which is reprinted by Gen Re, I’ve outlined the clinical phases, diagnosis and treatment of MR, as well as its possible complications. I hope the suggestions provided are helpful in improving your understanding of underwriting considerations for this complex but common condition.