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

Raphaël Demoulin1, Marie Agius1,2, Louis Marotte1,2

  • 1Department of Cardiology and Vascular Diseases, Hôpital National d'Instruction des Armées Sainte-Anne, Toulon Cedex 9 83800, France.

Military Medicine
|July 9, 2026
PubMed

Insights

Military cardiology services focus on fitness evaluations, not just disease management. Integrated care pathways streamline decision-making, especially for urgent cases, reducing wait times for service members.

Area of Science:

  • Cardiology
  • Military Medicine
  • Healthcare Systems

Background:

  • Effective coordination between primary care and specialist hospital medicine is crucial in military healthcare.
  • An embedded military cardiology service's role in cardiovascular care and fitness evaluation was assessed.

Purpose of the Study:

  • To evaluate the contribution of military cardiology to service members' cardiovascular care.
  • To assess the efficiency of fitness evaluations within the military healthcare system.

Main Methods:

  • Retrospective observational study of active duty and reserve service members referred for cardiology assessment in 2022.
  • Data collected included referral reasons, demographics, care pathways, timelines, and civilian care utilization.

Main Results:

  • 56.5% of patients had no cardiovascular disease identified; 28% were referred solely for fitness opinions.
  • Most care (84.3%) was within the military system.
  • Fitness-for-duty classification took a median of 70 days, significantly faster (7 days) with operational constraints but longer (232 days) with civilian referrals.

Conclusions:

  • Military cardiology's primary role involves screening and fitness arbitration over disease management.
  • Integrated military cardiology pathways facilitate operationally aligned decisions and reduce timelines for urgent cases.
Abstract

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