Open Access Open Badges Research article

Uptake of atrial fibrillation screening aiming at stroke prevention: geo-mapping of target population and non-participation

Johan Engdahl1*, Anders Holmén2, Mårten Rosenqvist3 and Ulf Strömberg24

Author affiliations

1 Department of Medicine, Halland Hospital, SE-301 85 Halmstad, Sweden

2 Department of Research and Development, Halland Hospital, SE-301 85 Halmstad, Sweden

3 Department of Clinical Science and Education, Karolinska Institute, Danderyds Hospital, Stockholm, Sweden

4 Department of Occupational and Environmental Medicine, Lund University, Sweden

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Citation and License

BMC Public Health 2013, 13:715  doi:10.1186/1471-2458-13-715

Published: 3 August 2013



In a screening study for silent atrial fibrillation (AF), which is a frequent source of cardiac emboli with ischemic stroke, the proportion of non-participants was considerable and their clinical profile differed from the participants’ profile. We intended to geo-map the target population and non-participation in an attempt to understand factors related to screening uptake and, thereby, obtain useful information needed to intervene for improved uptake.


In the municipality of Halmstad, Sweden, all residents born in 1934–1935 were invited to the screening study during April 2010 to February 2012. The total study group included 848 participants and 367 non-participants from 12 parishes. Geo-maps displaying participation, along with target-population-based geo-maps displaying proportion of immigrants and ischemic stroke incidence, were used.


Smoothed non-participation ratios (SmNPR) varied from 0.81 to 1.24 across different parishes (SmNRP = 1 corresponds to the expected participation based on the total study group). Among high risk individuals, the geographical variation was more pronounced (SmNPR range 0.75–1.51). Two parishes with higher share of immigrants and elevated population-based ischemic stroke incidence showed markedly lower participation, particularly among high-risk individuals.


AF screening uptake varied evidently between parishes, particularly among high-risk individuals. Geo-mapping of target population and non-participation yielded useful information needed to intervene for improved screening uptake.

Atrial fibrillation; Screening; Participation; Stroke prevention