Beyond Disease Management: The Fitness-for-Duty Arbitration Function of an Embedded Military Cardiology Service

INTRODUCTION: Military health care relies on coordination between primary care and specialist hospital medicine. This study assessed the decision-making contribution of an embedded military cardiology service to the cardiovascular care and fitness evaluation of service members. MATERIALS AND METHODS: Retrospective observational study including all active duty and reserve service members referred for a first cardiology assessment between 1 January and 31 December 2022. Collected data included referral reasons, demographic characteristics, care pathway, timelines, and any recourse to civilian care. RESULTS: A total of 115 patients were analyzed (mean age 39.6 years; 89.5% male). The main referral reasons were clinical symptoms (33.0%), asymptomatic electrocardiographic abnormality (25.2%), and cardiovascular risk assessment (23.5%). Beyond the medical referral reason, 28% of referrals explicitly requested a fitness opinion only, with no diagnostic or therapeutic objective stated. No cardiovascular disease was ultimately identified in 56.5% of patients. Care was delivered exclusively within the military system for 84.3% of patients. The median time from referral request to fitness-for-duty classification was 70 days, reduced to 7 days when an operational constraint was reported, but reaching 232 days when referral to a civilian facility for specialist care was required. CONCLUSIONS: Military cardiology activity is primarily driven by screening and fitness arbitration rather than disease management. An integrated pathway supports operationally aligned decision-making, with markedly shorter timelines when urgency is flagged.