A rapid review of pathways to diagnosis for people living with peripheral artery disease.

Background: Peripheral artery disease (PAD) remains under-recognised. Low awareness among the public, patients and healthcare professionals (HCPs) contributes to delayed diagnosis and poorer outcomes. This rapid review applied the Model of Pathways to Treatment (MPT) to synthesise behavioural and system-level factors shaping the diagnostic pathway and identifies evidence gaps to inform intervention and service redesign. Patients and methods: Databases (CINAHL, PubMed, PsycINFO) were searched (January 2001-July 2024) for qualitative, quantitative or mixed-methods studies exploring PAD diagnosis from the perspective of patients, at-risk public or HCPs. Eligible studies examined events, behaviours or timings linked to PAD diagnosis. Quality was assessed using the Mixed Methods Appraisal Tool and findings synthesised using the MPT. Results: Twenty-one studies (13 quantitative, 7 qualitative, 1 mixed method) were included. Mapping to the MPT revealed modifiable, multifactorial barriers across the diagnostic pathway from symptom appraisal to pre-treatment. At the patient level, symptom misattribution, normalisation, competing priorities, fear and financial concerns delayed help-seeking. At the provider level, HCPs often lacked training, confidence or incentives to assess PAD, with underuse of tools including the ankle-brachial index. At the system level, referral delays were linked to unclear pathways and limited feedback from vascular services. Only one study explored variations in diagnosis timeline by population or setting. Conclusions: Although PAD is under diagnosed and associated with poor outcomes, few studies have examined the behavioural and structural factors delaying diagnosis. This review identifies missed opportunities along the diagnostic pathway and highlights targets for future research and intervention across patient, HCP and system levels.