Through advancements in surgical interventions, Reference Moons, Bovijn and Budts1 patients with CHD are surviving longer and reaching adulthood. Reference Mandalenakis, Giang and Eriksson2 Adult CHD patients can increasingly maintain a physically active lifestyle, of which travelling constitutes an integral component. Reference Pickup, Bowater and Thorne3 Despite this, many adult CHD patients encounter significant barriers, one of which is travel insurance. Reference Pickup, Bowater and Thorne3
The 2020 European Society of Cardiology Reference Baumgartner, de Backer and Babu-Narayan4 guidelines acknowledged the significant challenges of obtaining life, health, and travel insurance for this group of patients. The premiums these patients are incurring are due to policies rather than related to the heart condition complexity, functional status, or prognosis. Reference Baumgartner, de Backer and Babu-Narayan4
Having valid travel insurance is paramount in this cohort, as some adult CHD conditions can cause significant mortality and morbidity. Reference Müller, Norozi and Caroline5 To provide appropriate care, it is imperative to guage the understanding towards travel insurance to improve guidance and support to such patients.
We assessed the travel habits of adult CHD patients to establish their Knowledge of the various travel cover options available in the United Kingdom. We also aimed to look at the number of adult CHD patients who were getting travel insurance based on their adult CHD severity and NYHA class. Lastly, we sought to investigate the effectiveness of our adult CHD outpatient services in providing sufficient travel guidance to these patients.
Materials and methods
Over two months, we distributed an anonymised questionnaire to adult CHD patients who attended outpatient cardiac services at University Hospitals Birmingham NHS Foundation Trust. We summated the responses and utilised descriptive statistics for data analysis. All adult CHD conditions were eligible for inclusion in the study. Partially and improperly given responses were excluded.
Results
132 patients completed the questionnaire, representing approximately 1% of the total adult CHD patients under follow-up. The cohort was evenly split, representing 50% (n = 66) of male and female patients. The median age of the study population was 33 years (range = 17–78 and standard deviation = 15). In total, 58% (n = 77) travelled abroad, 2% (n = 2) travelled within the United Kingdom, and 40% (n = 53) did not travel. Of those who travelled, 96% (n = 76) had travel insurance, and 4% (n = 3) did not have travel insurance.
Of the 76 insured patients, 28% (n = 21) had mild, 54% (n = 41) had moderate, and 18% (n = 14) had severe ACHD conditions (Fig. 1a). Furthermore, their NYHA class was as follows: 81% (n = 62) NYHA I, 9% (n = 7) NYHA II, 4% (n = 3) NYHA III, and 3% (n = 2) NYHA IV. Due to difficulty in grading, n = 2 were excluded. Of the 3 uninsured, n = 1 travelled overseas, and n = 2 travelled within the United Kingdom. Amongst the 3 uninsured, n = 1 had mild, n = 2 had severe ACHD conditions (Fig. 1a), and all were NYHA I.
Figure 1. ( a ) showing insurance trends according to ACHD condition severity. ( b ) showing percentage awareness of EHIC or GHIC.
Of the 76 insured patients who travelled, 78% (n = 59) declared cardiac condition, 21% (n = 16) did not, and n = 1 was excluded due to an incomplete questionnaire. 71% (n = 42) of ACHD patients who declared their cardiac condition incurred an increased insurance premium; however, 22% (n = 13) did not incur any additional insurance charges. Due to incomplete questionnaires, 7% (n = 4) of patients were excluded. Notably, 7% (n = 9) of the study population experienced travel insurance rejection due to their cardiac condition.
Of the 132 patients, only 13% (n = 17) found our adult CHD outpatient clinic services answered their questions regarding travel insurance. 60% of patients (n = 79) would have appreciated more information, and 27% (n = 36) were excluded. Only 39% of patients (n = 52) were aware of European Health Insurance Card or Global Health Insurance Card, 6 52% (n = 68) were unaware, and 9% (n = 12) were excluded (Fig. 1b). Out of 52 who were aware of health insurance cards, only n = 27 knew of the need to apply for a GHIC upon EHIC expiry, 6 n = 23 did not know, and n = 2 were excluded.
Of the total study population, 44% (n = 58) were interested in applying for GHIC or travel insurance in future, 33% (n = 43) were not interested, and 23% (n = 31) non-responders were excluded.
Discussion
The study demonstrates that many adult CHD patients travel, and those who travel also get travel coverage regardless of the severity of their adult CHD condition and New York Heart Association Functional Class (NYHA). However, a considerable proportion are not declaring their cardiac condition, potentially rendering their insurance invalid and putting them at risk of being unable to access healthcare abroad. The results also demonstrate that many patients who declare their cardiac condition incur a premium. It highlights the room for improvement in our adult CHD outpatient services in providing more guidance on travel, particularly as a substantial proportion of patients needed further travel information.
The study shows that many patients are unaware of European Health Insurance Card or Global Health Insurance Card; these are insurance cards issued by the United Kingdom government which cover medically necessary state-sponsored healthcare during travel within Europe, excluding a few countries. 6 Moreover, a significant proportion of patients were unaware of the post-Brexit changes implemented by the United Kingdom government to these cards, which has resulted in the need to apply for Global Health Insurance Card upon European Health Insurance Card expiry. 6 The study emphasises that many of our cohort were unaware of the various travel cover options but were interested in applying to them in future.
Around 97% of CHD patients now survive into adulthood. Reference Mandalenakis, Giang and Eriksson2 Therefore, it is becoming increasingly important to proactively provide advice on overseas travel to these patients. Organisations must use various multi-media approaches, such as social media and leaflets, to disseminate information about the travel cover options available to these patients. There is an urgent need for adult CHD specialists and insurance companies to come together to develop affordable travel insurance policies. This study also emphasises the importance of the ACHD Clinical Nurse Specialists having sufficient time with adult CHD patients to provide appropriate guidance on lifestyle issues.
Acknowledgements
None.
Financial support
This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.
Competing interests
None
