OBJECTIVES: To assess out-of-pocket expenses reported by patients receiving chronic treatment for atrial fibrillation (AF) in five European countries. METHODS: The EUPS-AF questionnaire was adapted from the 2008 Commonwealth Fund International Health Policy Survey of Chronically Ill Adults. Computer-assisted digital telephone dialling was used to screen a random sample from the entire adult populations of France, Germany, Italy, Spain and the UK. Structured telephone interviews were conducted between February and July 2011. RESULTS: Interviews were conducted with 1507 patients (France, n=300; Germany, n=300; Italy, n=302; Spain, n=305; UK, n=300). On average, 40% of patients had incurred no out-of-pocket expenses for medical treatment or services over the past 12 months (range, 18% [Italy] to 75% [UK]). Of the 582 patients who reported out-of-pocket expenses (mean, €705), 221 (44%) declared that the costs included those due to AF (mean, €466). The lowest mean out-of-pocket cost per patient for AF care was reported in France (€92 [median, €82], n=14) and the highest in the UK (€1573 [median, €114], n=29). The majority of out-of-pocket expenses for AF were non-medical costs for treatment and services not covered by insurance, including travel and household help. The proportion of patients who claimed cost as a reason for not filling a prescription or skipping doses ranged from 3% in the UK and Spain to 10% in France. Failure to receive treatment due to lack of reimbursement was experienced least frequently in the UK (1% of patients) and most frequently in Germany (28% of patients). CONCLUSIONS: The EUPS-AF highlights differences in out-of-pocket expenses and levels of treatment reimbursement that patients with AF have to pay in five European countries. Payers, healthcare policy makers and clinicians should all be aware that the financial burden of AF is linked to treatment adherence and may affect patient satisfaction and treatment outcome.