INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia in the elderly, and is associated with an increased risk of cardiovascular events (CVE). Hypoalbuminemia is an independent predictor of all-cause and cardiovascular mortality in general population. OBJECTIVES: The purpose of this work is to evaluate the possible predictive value of serum albumin (SA) on MACE occurrence, in a cohort of elderly patients with non-valvular AF and several comorbidities for long-term follow-up. METHODS: 1057 elderly with non-valvular AF were enrolled (75.92 ± 6.1years; 295 on VKAs and 762 on DOACs) and stratified according to median value of SA, 532 patients with SA ≤ 3.6 g/dL and 525 patients with SA > 3.6 g/dL. MACE (non-fatal ischemic stroke, non-fatal myocardial infarction and cardiovascular death), and non-cardiovascular mortality occurrence were evaluated during a median follow-up of 5.5 years (IQR 2.1-7.2). RESULTS: In the whole observational study, patients with SA ≤ 3.6 g/dL are associated with an increased risk of MACEs by 59%. In addition, 10-year ageing are associated with an increased risk of MACE; in contrast, a MNA score > 24 pt and therapy with DOACs are associated with a reduced risk of MACE. CONCLUSION: Elderly patients with non-valvular AF with SA ≤ 3.6 g/dL show a higher risk of MACE and non-cardiovascular mortality.