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KMID : 0365420080270010014
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Journal of the KLIMA
2008 Volume.27 No. 1 p.14 ~ p.17
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Potential Impact of the New Universal Definition of Myocardial Infarction on Critical Illness Insurance
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Pokorski Robert J
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Abstract
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Objective-The purpose of this article is to discuss how the new recommendation for a universal definition of myocardial infarction (MI) might affect critical illness insurance. Background-In 2000, the European Society of Cardiology and the American College of Cardiology issued a new definition for MI. Insurers worldwide who sold critical illness insurance changed the wording of the "Heart attack" event on new products to reflect this definition. An update of the MI definition was issued on 27 November 2007. It is likely that this new definition will be adopted by clinicians worldwide. Insurers may need to modify the definition and/or the pricing basis for the "Heart attack" critical illness event. Results-There are new criteria for MI associated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent thrombosis, and MI diagnosed via imaging, but the changes are fairly minor. There is greater emphasis on the diagnosis of sudden death due to MI (which could present claims and pricing difficulties for insurers in some markets). The article lists events that are not considered MI. Troponin, and not creatine kinase (CK) or the MB fraction of CK (CKMB), is clearly the preferred cardiac biomarker. Since new assays are able to detect much smaller increases in troponin, many of the infarctions detected in the future will be very small events (micro-infarctions) that were not considered when pricing the product. Conclusions-This new definition will increase the incidence of MI worldwide. It will also have implications for life and living benefits insurance. The authors state that "Further refinement of the present definition will doubtless occur in the future."
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KEYWORD
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Myocardial infarction, troponin, critical illness insurance
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