Atrial fibrillation is the most frequently encountered sustained arrhythmia in medical practice, and its prevalence increases with age. The population is aging due to improvements in the healthcare system; old age is not synonymous with frailty. Therefore, early recognition is crucial to prevent clinical homeostatic imbalance. Early identification of frail elderly patients is a daily task for various healthcare professionals, including general practitioners, emergency physicians, cardiologists, gerontologists, and physiatrists, among others. This identification helps protect these patients from the complications of supraventricular cardiac arrhythmia and its consequences, such as heart failure, cognitive impairment and dementia, frequent hospitalizations, worsening renal function, systemic embolisms, and stroke, as well as from frailty itself, among other pathologies.

This group of patients requires proper evaluation and stratification into robust, pre-frail, and frail patients so that appropriate preventive treatment with direct-acting anticoagulants contributes to the patient's improvement, rather than exacerbating the problem. It is important to recognize that very elderly patients may experience falls, be on multiple medications, and/or suffer from bleeding.

DOACs are a group of drugs that are administered, eliminated quickly, have few drug interactions, do not require dose monitoring, have been in use for more than a decade, and are supported by pivotal randomized controlled trials and observational studies of daily life, making them first-line candidates over vitamin K antagonist anticoagulants.

Daniel Victor Ortigoza, MD, cardiologist, former electrophysiology fellow at Dr. Cosme Argerich Hospital, Buenos Aires, Argentina. Member of the Argentine Federation of Cardiology (FAC), former president of the Arrhythmia and Electrophysiology Committee, vice president of the Cardio-Oncology Committee (FAC), member of the Arrhythmia and Sudden Death Council of the Inter-American Society of Cardiology (SIAC), member of the Spanish Society of Cardiology (SEC), currently part of the cardiology team at the Morón Municipal Hospital and the Syrian-Lebanese Hospital of Buenos Aires.