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Health Screening: MOT for Your Body – Is It Worth It?

A total body MOT (Medical & Occupational Test – not to be confused with the Ministry of Transport Test for your car) is a comprehensive health check that evaluates various bodily functions, including cardiovascular, respiratory, and metabolic health. But is it worth it? That depends on individual circumstances.

an illustration of MOT Tests logo

Key Questions Before Setting Up a National Screening Program

Before we get to the self-paid MOTs, there are a few key points to clear up if a taxpayer funds the national program:

What Can Screening Do?

Screening can detect conditions early, which is a clear advantage if an intervention is available that helps prolong life or improve its quality. Otherwise, early detection can lead to anxiety and distress. Additionally, early detection may result in over-testing, biopsies, etc.

Example: Cancer Screening and Adding Years of Life

As a warning: The data is tough to chew through.

While I initially assumed screening methods like mammograms, colonoscopy, fecal occult blood testing (FOBT), CT for lung cancer, and PSA for prostate cancer would consistently add years to life, the evidence has been mixed. The impact on lifespan is not sure enough for the NHS to support it all.

 

The NHS does:

  1. Mammography screening for breast cancer: Offered in the UK in 50-70-year-old ladies every 3 years.
    • The NHS reports that mammography screening diagnoses 8 per 1,000 women, with half of these cases too small to detect through palpation. In a 2012 review, the NHS found that screening reduced the breast cancer death rate by 20%.
  1. Fecal occult blood testing (FOBT) for colorectal cancer: Home testing kits are available to those aged 54-74 every two years.
  1. Colonoscopy: Provided to those with a high risk of colon cancer (e.g., due to family history) to allow for early polyp removal, which can prevent cancer.

Basic Screening Information

Screening isn’t a one-size-fits-all approach, and there are key points to consider:

Who Should Be Screened?

Is screening beneficial for everyone or only for specific groups, like men over 50? It should be clear who will benefit from the screening. For instance, breast cancer screening usually excludes men because of its low incidence in this group.

How Often Should You Do Screening?

Daily, yearly, every 5 years?

The intervals should be based on evidence to see a change or benefit without causing unnecessary testing.

In effect – How long do you get your “Get Out of Jail Free” card for?

a Get Our of Jail Free Card illustration from Community Chest

What is the Cost of Screening?

If the screening test costs £1000000 but picks up 100% of the disease and reduces mortality to zero, is it worth it?

All tests cost money, and that is not the only price.

Cost VS Benefit test illustration

Is a Health MOT Worth It? Not just cancer…

Here’s a breakdown of the potential benefits and considerations for a health MOT if you’re opting to pay privately:

Benefits of Health MOT:

  • Preventive Health Monitoring: It can identify underlying health issues, such as heart disease, diabetes, or cancer, before symptoms appear, allowing for early intervention. This is probably why most people do these tests.
  • Comprehensive Insight: It provides an in-depth overview of your overall health, from blood work to organ function, which can be reassuring. Some people might want this extra information.
  • Personalised Recommendations: Results often lead to tailored advice on lifestyle changes, diet, or treatments, improving long-term health outcomes.
  • Peace of Mind: For those with family histories of specific diseases or existing concerns, it can reduce anxiety by offering clarity. The risk is creating more anxiety, and the physician looking at the tests and delivering them has a massive responsibility to make sure reassurance is given.

Considerations for Health MOT:

  • Cost: These tests can be expensive, and not all findings may be actionable, potentially leading to unnecessary treatments or further tests.
    I worry specifically about genetic testing or MRI for dementia, given there is no treatment.
  • Overtesting: Some argue that routine tests without symptoms may lead to overdiagnosis, finding minor issues that would never cause problems but might lead to stress or unnecessary procedures.
  • False Positives/Negatives: Test inaccuracies can lead to unnecessary worry or missed conditions.
    The false negative – i.e. it missed something important- is particularly risky.

Who Might Benefit Most from Health MOT Screening?

Health MOTs are particularly beneficial for:

  • People Over 40: Especially those at risk due to family history or lifestyle.
  • Those with Chronic Conditions: Useful for monitoring ongoing health.
  • Health-conscious Individuals: For those who desire a thorough understanding of their body’s condition.

For generally healthy individuals, regular GP check-ups may suffice.

We are talking here about longevity. You have the money to spend – can you spend it on making sure you live longer? Venture capitalists invested over $4 billion in longevity start-ups in 2022 alone.

What Are the Screening Choices Available in the UK?

Here’s the breakdown – it’s a case of “you get what you pay for.”

Price is what you pay. value is what you get Warren Buffett quote

However, it’s still uncertain if these tests are definitively proven to extend your lifespan or improve health. Information is helpful, but solid evidence is needed, and for many of these options, that’s lacking. So, is it worth spending £200, £500, £5,000, or even £10,000?

Each option includes basics like blood tests, blood pressure checks, height, and weight—services also offered by your GP, though the range of blood tests may vary.

Provider Test Price ECG CT MRI Additions
Neko Health Nekoscan £299 Yes No No Unique scan from Spotify’s founder with limited evidence for disease prevention
Bluecrest Complete £289 Yes No No Body composition analysis (fat/muscle ratio)
Nuffield Health 360 £765 Yes No No PSA for men over 50, chest X-ray if indicated
MRIPLUS Full Body MRI £999 No No Yes MRI only; may show benign abnormalities that require further testing
BUPA Be.Ahead £1069 Yes No No Optional add-ons include CT coronary or colon scan
Randox Health Signature Prestige £1750 Yes No No Bowel screening home test, body composition analysis, extensive blood profile
MRIPLUS Diamond £2999 No No Yes MRI plus blood tests
Phoenix Hospital Group Executive £5495 Yes Yes Yes Ultrasound
Preventicum Ultimate/Optimal £7000/£10500 Yes No Yes Liver Multiscan, exercise stress echo
Welbeck Longevity Core Executive £9000 Yes No Yes Carotid and testicular (for men) ultrasound, echocardiogram, Fibroscan

 

Note: I’m not endorsing any of these options. I would discuss the worries with a trusted Doctor 1st. You can book a consultation with me at One Welbeck Heart Health or get a private heart check at London Cardiovascular Clinic.

Final Thoughts: 5 Tips on Holistic Health

  1. Sleep: Aim for at least 7 hours per night—catching up on weekends doesn’t fully compensate!
  2. Diet: Eat at least five servings of fruits and vegetables, avoid ultra-processed foods, and try cooking at home.
  3. Exercise: Aim for 6,000 steps daily and get your heart rate up at least three times a week.
  4. Hydration: Drink around 2 litres of water each day.
  5. Lifestyle Choices: Limit smoking and alcohol, as both have minimal health benefits and can do substantial harm.

For individuals over 40, it’s advisable to get regular blood pressure checks, a pulse check, and blood tests for cholesterol, HbA1c (blood sugar), complete blood count, kidney function, and liver function.

These are my opinions, shaped by over 20 years as an NHS consultant. I’ve witnessed how medical advice has evolved, and while there may be no absolute truth, experience counts.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

TAVI Today: Highlights from the 27th September 2024 Meeting

On 27th September 2024, I had the privilege of attending and speaking at the TAVI Today meeting, which began with a comprehensive review of the current state of healthcare in the UK. Below are my key takeaways from the discussions:

Health and Care 

Siva Anandaciva from the King’s Fund shared how healthcare priorities have shifted. In the past, it was all about competition between institutions—financial control and meeting specific targets like four-hour A&E wait times or elective waiting lists were the focus; you could even get fired for not meeting them. These targets, however, always felt artificial.

Now, the focus is on broader determinants of health, and there are three essential shifts:

  • Moving care from hospitals to homes
  • Transitioning from analog to digital systems
  • Shifting from treatment to prevention

This is the labour manifesto—I fully agree that the three shifts are vital! However, it’s worth noting that social care still needs to be sorted out. If the door out of the hospital is blocked, with no social care, hospital beds remain full, making it impossible to admit and treat new patients.

UK TAVI Update

Raj Kharbanda presented an update on the UK TAVI registry, which started in 2007. It was only formally commissioned in 2023, but before that, we collected data because we, as doctors, wanted to. The registry serves two key purposes:

  • Quality assurance: Are we doing a good job?
  • Quality improvement: How can we do better?

Targets for TAVI procedures include:

  • Performing over 200 cases annually
  • Achieving more than 90% transfemoral access
  • Over 90% of non-general anaesthesia cases
  • Next-day discharge, with a median stay of three days

The problem, however, is that we don’t have a dedicated data entry person, and the hospital will need to fund this. The question is: How do I make it important enough for the hospital to agree?

Getting Patients to Treatment

Phil MacCarthy raised an important point about inequality in access to healthcare. This inequality is based on ethnicity, gender, and social deprivation. Outreach clinics could help bridge this gap by bringing mobile valve services to the population, but we need to prove that this is both cost-effective and useful.

Day Case TAVI 

At Imperial, we’ve made day-case TAVI a reality for one in five patients, which is a huge step forward. TAVI started as a major procedure, but now we’re pushing the envelope. The key is selecting patients based on social support and ECG readings, which suggests that a pacemaker is unnecessary. It’s a highly successful programme.

Long Waiting Lists: Financial Implications

 David Tuson detailed the financial side of TAVI procedures. The 18-week treatment target for cardiology is now only met in 60% of cases, and the increase in waiting times began even before TAVI became mainstream.

Regarding costs, the tariff pays £10,400 for an elective TAVI case and around £14,000 for a non-elective case. But here’s the catch: only contracted non-elective TAVI cases are paid. Since over 40% of the TAVI procedures we now do are non-elective, the hospital might not get paid for them. In 2018, the NHS had 20% of non-elective cases; this has now risen to 30%.

This could lead to a significant loss of income—up to £26,000 per case if we exceed the contracted volume for complex inpatient cases. It’s essential that our managers are aware of this.

The Waiting List Problem

Adrian Banning discussed the ever-growing TAVI waiting list. The number of cases continues to rise, but we need to keep up. We’re very good at what we do, with only a 1% mortality rate, but we can only perform up to five TAVI procedures daily. That’s our limit.

Some have suggested expanding TAVI outside of surgical centres, but I currently disagree with that idea for a few reasons:

  1. We need to utilise the current resources in the bigger centres fully.
  2. Smaller centres need more experience.
  3. There is no cardiothoracic surgical cover in smaller centres.

We could consider sending other cases, like pacing and devices, to smaller centres.

 There are no easy solutions here, but some of the goals we can aim for include:

  • Performing a minimum of 400 TAVI procedures annually
  • Allocating two TAVI days per operator
  • Training an HCA to prepare the valve
  • Increasing the UK TAVI volume by 100% in the next two years.

Summary

The TAVI Today meeting covered many of the key issues we know and provided some potential solutions. However, significant challenges remain, particularly around waiting lists and financial concerns, which must be addressed to ensure the system functions effectively.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

DC Cardioversion to Treat Atrial Fibrillation

Dr Malik diagnoses and treats atrial fibrillation (AF). Treatment options to restore the heart’s rhythm and return it to normal include:

  1. Medication
  2. DC Cardioversion
  3. AF Ablation

Below is a short video of a successful DC cardioversion procedure carried out at his Central London base, One Welbeck Heart Health – the largest cardiology practice in the UK. Dr Malik is a founding partner and was the first Medical Director.

Link to Video

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

Team GB Medics Save a Life: Uzbekistan Coach Survives Cardiac Arrest

In a life-threatening situation, timing and expertise are everything. Recently, Team GB medics showcased the importance of these two elements when an Uzbekistan coach suffered a cardiac arrest during a sports event. Their quick thinking and swift action undoubtedly saved a life.
 

What is Cardiac Arrest?

A cardiac arrest happens when the heart suddenly stops beating, causing the person to collapse.

There are three types of cardiac arrest:

In this type, the heart’s electrical activity becomes chaotic and uncoordinated, causing the heart to stop beating. Immediate defibrillation can reset the heart to its normal rhythm. This is what the Uzbekistan coach experienced, and it’s the most survivable form of cardiac arrest—provided CPR is given immediately, and defibrillation is done quickly. Team GB medics were on hand to provide exactly that.

  • Asystole

This is when there’s no electrical activity in the heart at all. Unfortunately, this is usually an end-stage scenario and cannot be saved. If ventricular fibrillation isn’t treated promptly, it can progress to asystole.

  • Pulseless Electrical Activity (PEA)

Here, the heart’s rhythm may look normal, but there is no pulse or cardiac output. Various factors can cause PEA, and a rapid diagnosis and correction of the cause are crucial.
 

Is Cardiac Arrest the Same as a Heart Attack?

No, a cardiac arrest is not the same as a heart attack. 

A heart attack occurs when a coronary artery is blocked. This can lead to electrical instability in the heart and result in ventricular fibrillation, which may then cause a cardiac arrest. That’s why it’s essential to be in a hospital if you’re experiencing a heart attack.
 

How Can I Avoid a Cardiac Arrest?

The best way to avoid a cardiac arrest is to keep your heart healthy. If there’s a strong family history of sudden cardiac death, it’s important to get assessed. You should also control all the heart health risk factors: blood pressure, weight, smoking, blood sugar, and cholesterol.
 
If you have any concerns or want to discuss your heart health, I encourage you to come and see me. Taking action now could make all the difference.
 
Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

Dr Malik Tries Out Augmented Reality for TAVI

At the Abbott Heart Symposium on TAVI, you had the chance to try a Virtual Reality headset.

This amazing tool lets you walk in and out of a heart and explore it from all angles!

With the headset on, I could see nothing but the heart and moved around using the two-hand controllers. An expert guided us, “slicing” the heart to show key features such as the aortic valve, mitral valve, and left atrial appendage.

A photo showing Dr. Iqbal Malik using a Virtual/Augmented Reality headset at a TAVI Symposium

This 3D view of the heart is great for beginners to understand its structure.

 For Transcatheter Aortic Valve Intervention (TAVI), this VR model is a bit too complex for now. The CT scans, which I analyse using the 3Mensio software, already give us a lot of important information.

 I can see how we might use this to plan complex congenital heart disease procedures. For example, by inserting differently shaped equipment into the virtual model. Currently, we do this by 3D printing a model and physically inserting the devices.

This VR system could become even more useful in the future, helping us plan heart procedures more effectively.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.

Dr. Malik Attends the Abbott UK and Ireland Annual Meeting 2024

I had the pleasure of being on the faculty for this year’s Abbott UK and Ireland annual meeting. Just like last year, I was enthusiastic about the opportunity. I chaired the midday session, engaging a diverse audience of consultants, trainees, and healthcare professionals, encouraging them to think and participate actively.

Sponsored by Abbott, the meeting naturally focused on their TAVI valves. The latest version, previously known as Portico and then Navitor, is now called Vision.

A photo of Dr. Malik's badge for attending Structural Heart UK&I

What Did I Learn?

We were introduced to some fascinating 3D virtual reality aids designed for teaching doctors anatomy, allowing them to “walk through” the heart. While it’s not yet useful for planning complex TAVI procedures, I believe it will be in the future!

Having a surgeon present was beneficial as well. We debated how young a patient can be to undergo a TAVI. My youngest patient was 30, with complex heart disease and two previous operations. We performed an emergency TAVI with great success, which will lower the risk for future surgeries, sorted the acute leaky valve, and gave the heart time to recover.

In the USA, people in their 60s often demand and receive TAVI procedures. However, the fastest-growing surgical procedure there is removing failed TAVI valves. Hence, every patient I perform TAVI on goes through a thorough discussion process, including a Multidisciplinary Team Meeting (MDT). This ensures that the safest and best option is chosen for both the present and the next 20 years, whether it’s TAVI, surgery, or simply watching and waiting.

Additionally, we discussed precise valve sizing for each patient. This involves accurate CT scan measurements, assessment of coronary anatomy, calcium distribution, other heart diseases, the risk of needing a pacemaker, and, especially for younger patients, planning for the next procedure in 5-10 years.

What Is New?

Abbott has launched the Vision valve with markers for perfect deployment. It’s a self-expanding valve, and we saw it in action during the meeting.

A graphic shows a new self-expanding tavi valve by Abott

Medtronic introduced the Evolut FX Plus, which is more flexible and has larger gaps to facilitate future coronary artery access. This is also a self-expanding valve.

A graphic showing a self-expanding tavi valve by Medtronic

Edwards presented the S3 Ultra Resilia, featuring a new anti-aging treatment. It’s a balloon-expandable valve.

A graphic showing a baloon expandable tavi valve by Edwards

Summary

I always choose the right valve for each patient, having used products from three different companies so far, with more innovations on the horizon. It’s always a pleasure to be invited to such meetings, especially to chair interesting and educational sessions. Every good teacher knows that every day is a learning opportunity.

See Dr. Malik perform live cases:

If you have any questions about the procedure, don’t hesitate to contact us today.

Article by Dr Malik, a UK leading cardiologist. He works at One Welbeck Heart Health – London’s Largest Private Cardiology Group, and at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, one of the largest NHS Trusts in the UK.