In previous studies regarding DOACs compared to VKAs in AF out-patients with HF, 57% took ACE inhibitors and 68% took β blockers in the RE-LY trial [7], and 60% took ACE inhibitors and 69% took β blockers in the ROCKET AF trial, in which rivaroxaban tended to decrease all-cause mortality (RR 0.93, 95% CI 0.82–1.07) [9]. This evidence concerns the gene ACE and hydrops fetalis.