{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:58:50Z","timestamp":1787763530480,"version":"build-2784847793"},"reference-count":16,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag324","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:23:39Z","timestamp":1783617819000},"source":"Crossref","is-referenced-by-count":1,"title":["Beyond Disease Management: The Fitness-for-Duty Arbitration Function of an Embedded Military Cardiology Service"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5055-4234","authenticated-orcid":false,"given":"Rapha\u00ebl","family":"Demoulin","sequence":"first","affiliation":[{"name":"Department of Cardiology and Vascular Diseases, H\u00f4pital National d\u2018Instruction des Arm\u00e9es Sainte-Anne , Toulon Cedex 9 83800,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Agius","sequence":"additional","affiliation":[{"name":"Department 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83800,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisson","family":"Adet","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Diseases, H\u00f4pital National d\u2018Instruction des Arm\u00e9es Sainte-Anne , Toulon Cedex 9 83800,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"Pons","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Diseases, H\u00f4pital National d\u2018Instruction des Arm\u00e9es Sainte-Anne , Toulon Cedex 9 83800,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonore","family":"Capilla","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Diseases, H\u00f4pital National d\u2018Instruction des Arm\u00e9es Sainte-Anne , Toulon Cedex 9 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