A. Garcia Lledohas provided scientific advice to Bristol-Myers and Bayer and has given presentations and classes in courses sponsored by Pfizer and Boehringer.

2013, echocardiograms were recorded for 748 patients with atrial fibrillation but without a valve prosthesis, and with a CHADS2 score of 1 or more. The patients with valve lesions are shown in the Table. In terms of their valve lesions, 655 patients (87.6%) would correspond to the clinical profile of ARISTOTLE 4 and ENGAGE AFTIMI 48 trials. 5 Between 590 and 655 (78.9% and 87.6%) would correspond to the ROCKET profile. 3 It is more difficult to determine how many would correspond to the RE-LY profile 2 and how many would have NVAF. This would depend on the threshold for NVAF. If NVAF requires ‘‘hemodynamically relevant valve disease’’, between 161 and 276 patients could be included (21.5%-36.9%). These notable differences highlight the weakness of the term NVAF when selecting patients for treatment with NOACs. These data cannot be extrapolated to the general population because the patients were referred for echocardiography. Nevertheless, they may be representative of a large proportion of patients with different types of valve lesions and atrial fibrillation. The authors of the ARISTOTLE trial reported that more than a quarter of the patients in the study had valve lesions that could be considered significant. 6 In these patients, the benefit of apixaban was similar to that in patients without valve lesions. This finding may dissipate doubts about the risk of using NOACs, or at least apixaban, in patients with valve lesions other than mitral stenosis. In the ROCKET trial, 14% of the patients were considered to have significant valve lesions. The clinical trials show that NOACs, or at least factor Xa antagonists, can be used in patients with atrial fibrillation who do not have mechanical prostheses 2–5 or significant mitral valve stenosis, 3–6 although they may have other valve lesions, whether or not they are significant. This point is essential, as atrial fibrillation is the most frequent sustained arrhythmia, while mitral valve stenosis is becoming less frequent. The term NVAF does not seem appropriate as an umbrella term for patients who may benefit from NOACs. Not only is this term not representative, but it is also not defined in the guidelines and may lead to inappropriate