“…In fact, studies by Svennberg et al [65] and Lowres et al [67] describe examples from public health policies with good incremental cost-utility ratios between €3142 and €6267. As far as the second problem is concerned, achieving appropriate implementation of stroke prophylaxis guidelines in the real world has proved to be a true challenge, because many factors may play a role, including physicians' previous outcomes and difficulties with international normalized ratio targets, as compiled by Jannou et al [11], although the current availability of the direct oral anticoagulants is overcoming some of these concerns and inducing a higher preventive treatment implementation of AF-related stroke. Thus, the missed opportunities for stroke prevention in AF, highlighted by Gladstone et al [50] long ago, persist in our everyday practice, and our failure to implement quality improvement interventions over this time should persuade us once more to optimize stroke prevention and thus reduce their number and associated costs.…”