The EUROSAF Symposium in Berlin, held in the framework of the EUGMS Congress the 12th October 2018, offered to the scientific community a new perspective about the use of oral anticoagulant in treating Atrial Fibrillation. The preliminary analyses of data collected by the EUROSAF researchers revealed that the Multidimensional Prognostic Index (MPI) seems to be very useful to really evaluate the cost-effectiveness of oral anticoagulant treatments in a real-world population of very old and frail subjects with AF. Even if preliminary, these data are quite significant in numerical terms: in fact, at the 1st September 2018, the EUROSAF database included 1040 older subjects with AF, with a mean age of 83.2±7.6 years and a good stratification in MPI classes: 39% of subjects were in MPI-1, 36% in MPI-2 and 25% in MPI-3 class. The participants to the EUROSAF Symposium, co-chaired by Stefania Maggi (Padova, Italy) and Heidi Gruner (Lisboa, Portugal), had the occasion to listen to the presentation of Dr. Maria Cristina Polidori (Ageing Clinical Research Cologne) titled “Anticoagulants in Atrial Fibrillation: RCTs, real life and guidelines” and to the intervention of Dr. Timo Strandberg (University of Helsinki) titled “Prevalence and consequences of atrial fibrillation in older people”. Dr. Pilotto (Galliera Hospital, Genova, Italy and scientific coordinator of the EUROSAF Study) closed the Symposium with a talk entitled “From guidelines to personalized treatment in older people” and the presentation of the preliminary data of EUROSAF Study, followed by a very interesting debate, closed with the request of inclusion of 4 new centers in the Study. A great success though, but the best is still to come.