Cardiomyopathy

Here you'll find our current definition of the critical illness, additional condition or child specific condition we cover. We've also listed any previous definitions we may have had. With each new definition we've highlighted what's changed from the previous definition.

Current definition

March 2020

Cardiomyopathy - of specified severity or undergoing a defined treatment

A definite diagnosis by a consultant cardiologist of cardiomyopathy. The disease must result in at least one of the following:

  • left ventricular ejection fraction (LVEF) of 39% or less measured twice at an interval of at least 3 months by an MRI scan,
  • marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain (Class III or IV of the New York Heart Association classification) over a period of at least 6 months, or
  • undergoing of, or inclusion on the NHS waiting list for, implantation of a cardioverter defibrillator (ICD) on the specific advice of a cardiologist for the prevention of sudden cardiac death.

For the above definition the following are not covered:

  • all other forms of heart disease, heart enlargement and myocarditis.

Changes from the previous definition

We've added advanced surgery benefit so that we now pay out on inclusion on NHS surgery wait list.

Previous definitions

Cardiomyopathy – of specified severity or undergoing a defined treatment

A definite diagnosis by a consultant cardiologist of cardiomyopathy.

The disease must result in at least one of the following:

  • left ventricular ejection fraction (LVEF) of 39% or less measured twice at an interval of at least 3 months by an MRI scan,
  • marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain (Class III or IV of the New York Heart Association classification) over a period of at least 6 months, or
  • implantation of a cardioverter defibrillator (ICD) on the specific advice of a cardiologist for the prevention of sudden cardiac death.

For the above definition the following are not covered:

  • all other forms of heart disease, heart enlargement and myocarditis.

Changes from the previous definition

We've expanded the definition so that it now covers all secondary cardiomyopathies.

Primary cardiomyopathy – of specified severity or undergoing a defined treatment

A definite diagnosis by a consultant cardiologist of primary cardiomyopathy. The disease must result in at least one of the following:

  • left ventricular ejection fraction (LVEF) of less than 40% measured twice at an interval of at least 3 months by an MRI scan,
  • marked limitation of physical activities where less than ordinary activity causes fatigue, palpitation, breathlessness or chest pain (Class III or IV of the New York Heart Association classification) over a period of at least 6 months, or
  • implantation of a cardioverter defibrillator (ICD) on the specific advice of a cardiologist for the prevention of sudden cardiac death.

For the above definition the following are not covered:

  • any secondary cardiomyopathy,
  • all other forms of heart disease, heart enlargement and myocarditis.

Changes from the previous definition

We now cover left ventricular ejection fraction (LVEF) of less than 40% measured twice at an interval of at least 3 months by an MRI scan.

Cardiomyopathy – of specified severity

A definite diagnosis by a consultant cardiologist of cardiomyopathy resulting in permanent loss of the ability to perform physical activities to at least Class III of the New York Heart Association (NYHA) classification. This means there is marked limitation of activities, with less than ordinary activity causing fatigue, palpitations or shortness of breath.

The diagnosis must also be evidenced by:

  • electrocardiographic changes; and
  • echocardiographic abnormalities.

The evidence must be consistent with the diagnosis of cardiomyopathy.

For the above definition, the following are not covered:

  • all other forms of heart disease and/or heart enlargement;
  • myocarditis; and
  • cardiomyopathy related to alcohol or drug abuse.