Introduction

Improvement in the diagnosis and management of children with congenital heart disease (CHD) has led to a rapid increase in the population of adults with heart defects. These numbers are now approaching one million in North America, with more adults (aged > 16 years) than children with CHD . A similar increase has occurred in Western Europe . While lifespan has increased markedly for these patients, little is known about their ability to obtain a mortgage or consumer loan. Mortgage application is often a necessity and a source of anxiety for most individuals; and this anxiety is often amplified in CHD patients. Questionnaire studies of provider companies and consensus statements suggest that most adults with CHD would be denied insurance or subject to higher rates . A number of large-scale, long-term studies are available for evaluating outcomes in many cases of CHD. This has facilitated the approximation of mortality risks compared with a healthy control population, which in turn has been implemented as the basis of policy formulation by mortgage insurance companies. However, the risk rate is not identical for all insurance companies and the heart defect prognosis varies according to the lesion. The AERAS convention ( s’Assurer et Emprunter avec un Risque Aggravé de Santé ) aims to expand access of loans to persons who have or have had a severe disease. This consensus was signed in January 2007 by governments, banking trade associations, public and private insurance companies and associations of consumers and patients. Nevertheless, the loan application status of patients with CHD in France remains unknown.

To determine the consumer loan and mortgage status in adults with CHD within France, we investigated obtainment of a mortgage or consumer loan in a cohort of CHD patients. We were particularly interested to establish whether congenital heart lesions have a specific effect on mortgage and loan application outcomes.

Population and methods

From the database of our adult CHD unit, 476 patients with CHD were selected and contacted by phone. Patients aged less than 30 years at the time of contact were excluded. Indeed, more than two-thirds of loan applications are made by people aged more than 35 years, according to the French property market . Patients with learning difficulties, lost to follow-up, who were living abroad, deceased or with learning difficulties were also excluded from further study. We made three separate attempts to reach patients by phone and request their participation in our study. One hundred and forty-two patients agreed to participate.

Patients were classified according to the Bethesda classification, which takes into account the severity and complexity of heart disease. The CHD population was divided into ‘mild’, ‘significant’ and ‘complex’ groups. Heart lesions were grouped as: ‘mild’ when they were simple heart diseases with good outcome (normal or near normal prognosis) and only in need of observation; examples of these are mild aortic or mitral regurgitation, mild pulmonary stenosis and repaired atrial or ventricular septal defect. CHDs with moderate complexity and intermediate outcome, where correction has been attempted but likely requires further intervention, were classified as ‘significant’; these included tetralogy of Fallot, repaired coarctation and repaired complete atrioventricular septal defect. CHDs with greater complexity and an uncertain or poor outcome, such as Eisenmenger’s syndrome, cyanotic congenital heart, Fontan circulation, single ventricle or lesions with the right ventricle supplying the systemic circulation, were classified as ‘complex’.

Patients were further classified according to their socioprofessional category defined by INSEE (National Institute of Statistics and Economic Studies; Table 1 ). Complications related to their heart disease, cardiovascular risk factors and other co-morbidities (such as cancer) at the time of loan application, were collected. Finally, we asked whether the patient had sought advice on insurance company policies from a patient association.

Statistical analysis

All values were expressed as mean ± standard deviation (SD). Statistical analyses were performed using Statview V.5.0.1 software (Adept scientific, Letchworth, UK). Differences in quantitative variables between patient groups were analysed by studying the variances. The Chi-square test was used to compare proportions.