I have no idea, but if someone has had a heart attack I know that one thing that won’t hurt their feelings is finding affordable life insurance rates. While I may not have a clue about broken hearts, I can shed some light on what life insurance underwriters look for when underwriting heart disease and heart attack cases.

The difference in underwriting is very subtle between heart disease (CAD) and heart attacks. The real difference has to do with the problem being diagnosed before or after damage (ischemia) has occurred in the heart. If the damage is minimal the underwriting outcome will be virtually the same. As the damage level increases, rates become higher due to the weakened condition of the heart and subsequent possible shortened mortality.

Having said that, life insurance underwriters look at several key factors in weighing the risk.

1. Age of onset. This one isn’t too hard to imagine the impact. Just consider for a moment the difference in your reaction upon hearing that a 35 year old cousin had heart bypass surgery versus hearing that his father, a 60 year old, had the same occurrence. There isn’t anything normal about a young person having cardiac issues, so age of onset is important to underwriting. Generally, prior to 50 is going to increase the rates and prior to 40 will increase the rates dramatically.

2. How many vessels were involved? Whether there was a heart attack or not, we are generally talking about either bypass surgery or placement of a stent through angioplasty. The number of vessels is some indication of not only severity, but chance of recurrence. A one vessel issue will receive more aggressive underwriting than, say, four or five vessels.

3. Recurrence. It is not uncommon with chronic CAD for a person to have to go through more than one procedure. If these are less than three months apart it is generally looked at as one event and wouldn’t be considered chronic. Often these occurrences are years apart and that presents an obvious increased risk to the insurance company. As long as the heart, as shown through the results of a stress test, is still strong, insurance should be attainable although at higher rates.

4. Heart damage. Before accepting a risk on a cardiac case, insurance companies will want to see a stress test done post heart attack/bypass/angioplasty. Even 10 or more years out from the event, if a person hasn’t had a stress test within the previous two years, insurance companies will likely require one before considering approval. The primary assessment of heart damage from the stress test is the left ventricular ejection fraction (LVEF). This, simply put, is a measure of how efficiently your heart is pumping blood. A normal LVEF would generally be around 65%-70%. Insurance companies will generally not consider coverage if the measurement is below 50%.

5. Lifestyle. Underwriters pay close attention to whether or not the event got your attention. If you’ve had a cardiac event and, say, continue to smoke, if you are approved it will be at an extraordinarily high rate. Most companies will simply decline to accept the risk. They also look at fitness issues such as exercise and obesity.

Bottom line. Fair rates on life insurance are available for the majority of people who have been through a cardiac event. Thanks to modern medicine far less damage occurs on average than used to occur. What this means for insurance companies is that, rather than knocking someone out of the running for life insurance, it keeps them in the running and with the survival of the wake up call and lifestyle changes, mortality experience is good. You’re going to be around for a while.