The heart of the matter

Peter Arthur will be spending British Heart Week, which begins today, "chilling out" in the four-acre grounds of his home near Kingsbridge in south Devon. This will involve spending plenty of time with Pip and Bob, his seven-year-old Shetland ponies.

But however idyllic this situation may sound, it is one he wishes had never arisen. Mr Arthur, a 53-year-old executive chef, used to commute to work near Winchester in Hampshire every week. But since his heart attack this January he has been stranded at home on half-pay.

Fortunately, the £34,750 proceeds of a critical illness cover policy with Swiss Life should ensure he incurs no financial losses if, as expected, he returns to work by the end of the summer.

The single-life, combined critical illness cover and life assurance policy, which guaranteed to pay out on death or on diagnosis of one of 38 critical illnesses, cost him £34.30 a month. But it has proved so crucial his 55-year-old wife Chris, an administrative assistant, has taken out similar cover with Norwich Union.

Mr Arthur, who has a grown-up son and daughter, says: "The old saying that you never think it is going to happen to you is true, because I dismissed tell-tale signs as merely indigestion, although my doctor had told me my blood pressure was high. I would recommend anyone to have critical illness cover."

Although deaths from coronary heart disease dipped marginally last year, it is still the most common cause of death in the UK, killing one in four men and one in six women. Every two minutes, someone suffers a heart attack and more than 1.5 million people in this country have angina and 500,000 have heart failure. In fact, one of every six 30-year-old men has a heart attack before the age of 65.

But the numbers who survive are increasing. Medical advances mean doctors are able to treat many more conditions, although new procedures, drugs and technology swallow up cash. The man who 30 years ago would have died outright can have a heart transplant.

This is a growing problem for the National Health Service, which can create a moral dilemma for someone with the money to take out private medical insurance. Demand for coronary artery bypass surgery and other techniques is creating huge pressure on the NHS.

The lengthening waiting lists are a strong incentive for people to take out private medical insurance (PMI) and nearly seven million people in the UK have it. They know if they become ill or need an operation they can get treatment promptly and they can exercise choice.

A critical illness policy pays a tax-free lump sum on the diagnosis of one of a stated number of critical conditions. One-third of all critical illness cover claims are for heart attacks and other conditions caused by coronary heart disease. Fortunately, policies are less confusing. The Association of British Insurers (ABI) Critical Illness Working Party ensured definitions for heart attack, stroke, coronary artery by-pass surgery, aorta graft surgery and heart-valve replacement or repair were subject to industry-wide standardised wordings since July 2000.

The working party has also been responsible for broadening the definition of heart attack to include the use of troponin tests, a quick, cheap and accurate method of diagnosis now used by two-thirds of hospitals.

But cardiomyopathy, a hardening of the heart muscle, and angioplasty, the enlarging of an artery that has become flattened or restricted are not subject to standardised wordings. The former is covered by only a handful of insurers, but the latter by the majority.

Alan Lakey, a partner at Highclere Financial Services, a specialist independent financial adviser (IFA) in Hemel Hempstead, Hertfordshire, says: "These days, consultants are increasingly turning to angioplasty rather than performing open-heart surgery, and the varying definitions of this can vary do not receive all the attention they deserve. Legal & General and Norwich Union limit cover balloon angioplasty, but there are four other angioplasty techniques increasingly being used and some plans cover all of them."

Critical illness cover premiums have been rising steeply since last year as a result of the impact medical advances and improved diagnostic techniques are having on claims. The steepest rises, of 30 to 40 per cent, have been for policies which guarantee to fix premiums for the policy term. Reviewable rate policies, which regularly increase premiums on the basis of the insurer's overall claims experience, have risen by 15 per cent.

Brian Lentz, principal at Portfolio Insurance Consultancy, a specialist IFA in Hatfield, Hertfordshire, says: "Premiums had been falling for the best part of 10 years, so they are still competitive with a couple of years ago and they could well continue to rise for some time.

"The security afforded by guaranteed rates can still be worth paying for if you are covering specific requirements for a set term, say, a mortgage, but there are fewer and fewer providers offering these. If you want to protect yourself or your family you can be better off with a whole-of-life critical illness cover plan, which lasts your lifetime, than with a fixed-term plan with reviewable rates.

"Guaranteed rates are not available for whole-of-life critical illness policies, but premiums are usually guaranteed initially for 10 years and reviewed every five years. Many new fixed-term critical-illness policies with reviewable rates are moving towards five-year rolling reviews."

Anyone requiring guaranteed rate or reviewable rate fixed-term critical-illness cover can obtain significant discounts from a couple of low-cost intermediaries with knowledgeable staff willing to give personal advice. But, unlike the specialist IFAs, they are not permitted to offer whole-of-life cover.

The Health Insurance Shop, a low-cost intermediary based in Mere in Wiltshire, is able to undercut IFAs by up to a third and the national low-cost intermediary LifeSearch guarantees to better any quote you get during the last week.

But preventing heart problems should remain a major priority. The British Heart Foundation says a third of deaths from coronary heart disease are caused by poor diet. It recommends eating five or more portions of fruit and vegetables every day, keeping saturated fats to 10 per cent of intake and taking at least half an hour's exercise five days a week. Oh yes, you should cut your drinking and stop smoking, too.

HOW TO SURVIVE A HEART ATTACK

WARNING SIGNS

* Many heart attacks start as mild pain or discomfort that may come and go;

* Most attacks involve uncomfortable pressure, squeezing or pain in the centre of the chest that lasts, or fades and returns. It can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach;

* Shortness of breath, often before or with chest discomfort;

* Other symptoms may include cold sweat, nausea, or light-headedness.

WHAT TO DO

* Fast action is the best weapon against a heart attack, because clot-busting drugs and artery-opening treatments can stop it.

CUTTING THE RISK

* Stop smoking. One year after quitting, the risk drops to half that of regular smokers and gradually returns to normal in people without heart disease;

* Follow a healthy eating plan, including foods lower in salt and sodium and limit alcohol;

* Reduce high blood cholesterol;

* Aim for a healthy weight. There are two tests, waistline and body-mass index (BMI). Men should keep their waist below 40ins (101cm), women below 35ins (89cm). Calculate BMI by dividing your weight in kilos by your height (in metres) squared;

* You need to do only 30 minutes of a moderate-intensity activity most days.

Source: The National Heart, Lung and Blood Institute.