Optimising investigative pathways in military medicine: operational impact of a military cardiopulmonary exercise testing clinic.

Abstract

Introduction: Abnormal cardiorespiratory symptoms and investigative findings in service personnel typically result in prolonged investigation and occupational restriction. This analysis aimed to assess the impact of the Oxford Military Cardiopulmonary Exercise Testing Clinic (OMEC), which investigates such symptoms and findings, on occupational recommendations.

Methods: A service evaluation was conducted on all OMEC attendances over a 5-year period. Referral indication and occupational grading, demographics, exercise testing parameters, clinical diagnosis and occupational recommendation were recorded.

Results: 141 individuals were reviewed. Mean age was 36 (±11.3) years, and 91% were male. Median waiting time for an appointment was 14.4 weeks (cf NHS 17.4 weeks).Individuals were referred for dyspnoea (22.1%), syncope (11.4%), chest pain (8.1%) (referred to as 'higher risk' symptom group), and pre-syncope (8.1%), palpitations (8.1%), and fatigue and/or exercise intolerance (6.0%) (referred to as 'lower risk' symptom group). 34% were asymptomatic with incidental findings on cardiac screening investigations. Reduced exercise capacity was rare, affecting only 11% of individuals, which was borderline/mild at worst.Median peak VO₂ (as a percentage of the predicted peak) was lower in the higher-risk symptom group than in the lower-risk symptom group (97.8% vs 121%; p<0.001). This was also seen for median workload as %PP (82.6% vs 98.0%; p<0.001). 80.5% of patients were given an immediate occupational recommendation; 78% of which were favourable outcomes (ie, a recommended occupational upgrade (72%) or to remain fully deployable (6%)).

Conclusion: OMEC is tailored to the unique needs of the military population, providing outcomes that support operational requirements. Despite geographical distribution and operational commitments, OMEC waiting time is equivalent to the NHS, with the great majority of patients upgraded after attendance. These findings establish OMEC as a benchmark for military-specific clinical services based in public (NHS) hospitals, highlighting its role in facilitating rapid and effective occupational management.