Authors Christopher Wong and Gregory Marcus discussed findings from the DECAF randomized clinical trial, which evaluated whether daily consumption of caffeinated coffee, compared with abstinence from coffee and caffeine, affects the risk of recurrent atrial fibrillation (AF) or atrial flutter in patients with AF.
Study
The DECAF trial was an investigator-initiated, international, multicenter, randomized clinical trial evaluating whether caffeinated coffee consumption affects recurrence of AF or atrial flutter. The study included 200 patients with persistent AF, or atrial flutter with a history of AF, who were scheduled for electrical cardioversion.
Eligible patients had to have consumed at least one cup of caffeinated coffee per day at some point in the last five years. Eligibility also included people who were no longer consuming caffeinated coffee because of personal beliefs or physician advice regarding AF.
Following successful cardioversion, participants were randomized 1:1 to either consume at least one cup of caffeinated coffee daily or abstain from all coffee, including decaffeinated coffee, and caffeinated products. Follow-up lasted for 6 months or until an occurrence of AF or flutter. Median coffee intake in the coffee group was 7 cups per week, whereas median intake in the abstinence group was 0 cups per week.
Results
According to the primary analysis based on the intention-to-treat principle, participants allocated to caffeinated coffee had a 39% lower hazard of recurrent clinically diagnosed AF or atrial flutter compared with those assigned to abstain from coffee and caffeine during the study period. The hazard ratio was equal to 0.61 (95% confidence interval, 0.42-0.89; P=0.01). No differences in adverse events were found between groups.
The authors emphasize that the findings challenge the longstanding belief that caffeinated coffee can precipitate or worsen AF. At minimum, the results suggest that modest caffeinated coffee consumption, approximately one cup daily, is unlikely to worsen AF in most individuals, and whether coffee provides a direct protective benefit requires further investigation.
Conclusion
The DECAF trial challenges the longstanding practice of routinely restricting caffeinated coffee in people with atrial fibrillation. Among patients with AF or flutter undergoing cardioversion, consuming at least one cup of caffeinated coffee daily was associated with a 39% lower hazard of clinically detected recurrent AF or flutter over six months compared with abstaining from coffee and caffeine, with no differences in adverse events.
The findings suggest that modest consumption of caffeinated coffee is unlikely to precipitate or worsen AF in most patients. However, further research is needed to understand the mechanisms and determine whether caffeinated coffee provides a genuine protective benefit.
Source:
https://www.news-medical.net/news/20260812/The-coffee-advice-given-to-atrial-fibrillation-patients-may-deserve-a-rethink.aspx