The purpose of the present study was to evaluate clinical data and medical treatment of very elderly patients with atrial fibrillation (AF) who are under-represented in the majority of AF studies. In this retrospective study, patients over 80 years with AF admitted to the cardiology ward during a 1-year period were investigated with respect to the type of AF, clinical characteristics, and rate or rhythm control strategy. In addition, the influence of age and CHADS(2) score on antithrombotic therapy was examined. A total of 169 consecutive patients (mean+/-S.D. age: 84.7+/-4.0 years) were included in this study. Rate control medication was administered in 79% of the patients at discharge. Oral anticoagulation (OAC) was prescribed in only 27.5% of the patients with a CHADS(2) score of > or =2 for reasons of poor compliance or unfavorable clinical conditions. Moreover, patients older than 85 years received OAC less frequently than those aged between 80 and 84 years (7% vs. 36%, p<0.001). Our results indicate a real need for educational programs aimed at instructing all staff involved with this group of patients, so that the necessary pre-conditions for a maximum OAC therapy can be achieved in these very elderly AF patients.