Beyond anticoagulant therapy. The not benign impact of atrial fibrillation on patients’ outcomes in a real world ‘scenario’

Some weeks ago, while I was visiting an old lady with a first episode of atrial fibrillation (AF), a friend of mine, a very clever cardiologist and scientist, said: “Do not worry madam, you have an AF, the heart equivalent of an appendicitis”. Many cardiologists and internists still think that AF is a common but not severe cardiac condition, char- acterized by a benign prognosis provided that patients go on taking their anticoagulant medications. This concept is presently and con- tinuously challenged by some relevant evidence, which clearly de- monstrates how the clinical weight of AF goes well beyond that re- presented by the increased thromboembolic risk.