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.