In association with Sovereign
The “big three” of heart disease have traditionally been coronary heart disease (heart attacks), high blood pressure and heart failure. But a lesser-
known condition called atrial fibrillation (AF) is spiking in our ageing population. AF is a type of abnormal heart rhythm (arrhythmia) that can severely affect quality of life for some and, at its worst, increases the chance of having a stroke and shortening life.
While treatment plans are multi-faceted, one procedure that can have good results is pulmonary vein isolation (PVI). This procedure, a deliberate damaging of the inside of the heart (or, more specifically, electrical connections of veins) in order to reduce erratic electrical signals within the heart, is a rising trend in insurance claims.
“Sovereign has worked hard to learn about and adopt technology advances that can improve health outcomes for our customers,” says Sovereign CEO Nick Stanhope. “PVI has been in the top 10 health claims for the past two months, and the company is currently funding around three of these procedures per month, which can cost around $40,000.”
But exciting as this procedure is, it is neither a one-size-fits-all nor a cure.
“We’re aiming for good symptom control,” explains Dr Nigel Lever, who performs PVI procedures for Sovereign at Mercy Hospital (Auckland) and Braemar (Midland Cardiovascular Services, Hamilton). Lever is also involved in AF research at the University of Auckland.
Since the PVI procedure was established in 1998, progress has been dramatic, with success rates rising and complications reduced. The criteria for being eligible for PVI treatment is now quite standardised and everyone in the medical team, including the insurer, is invested in doing the procedure only in the right circumstances.
By the time the patient reaches the stage of being considered for PVI, they will have been through a lengthy diagnostic process and a range of treatments will have been trialled, some of which will continue beyond PVI.
“Sovereign places a lot of focus on supporting our customers upon their ‘moment of truth’,” says Stanhope. “We try to ensure a speedy and smooth process at the cover stage and our teams offer additional support during the customer’s medical journey.”
It’s a journey that can take place at public and private centres in Christchurch, Wellington, Waikato and Auckland.
So what exactly is happening in AF? Dr Lever describes the heart as a pump with two top chambers (the atria) priming two bottom chambers (the ventricles) to drive blood to the lungs and to the rest of the body. A natural pacemaker inside the heart co-ordinates the actions between the top and bottom chambers – ensuring an organised and efficient heartbeat.
In AF, the top chambers become highly erratic in terms of the speed and way they beat, with the electrical and mechanical efficiency lost. In most cases, this upset is being caused by electrical irritability starting from within the pulmonary veins, which then invades the rest of the upper chambers. These veins are the tubes that drain the fresh red blood from the lungs back to the heart. The sleeves of muscle covering the veins can become electrically irritable and act as the triggers.
The condition typically affects men aged 40-plus, but more and more women are presenting. For those worst affected, the condition makes them feel unwell; the heart racing irregularly severely curtails activities and can cause extreme distress. Risk factors include existing heart disease, hypertension, obesity, excessive alcohol intake and conditions such as sleep apnea.
Surprisingly, another group at risk are elite athletes who, by pushing their bodies to achieve in sport, may be prone to getting AF earlier than otherwise. This group may be asked to decondition. There’s also promising evidence that weight loss of 5-7kg for those who are overweight can help reduce symptoms, sometimes even negating the need for surgery.
Success rates are good, with around three-quarters of patients experiencing a big improvement in the normalising of their heart rhythm – in many cases, nothing short of a life regained.