New research from the University of California and the University of Adelaide is attempting to challenge the established medical caution around caffeine intake for people with atrial fibrillation (AF) and other cardiac issues.
For years, the standard advice for these patients has been to avoid caffeine for fear it will trigger or worsen AF symptoms. Now, this new research suggests that not only is it safe for people with AF to drink coffee, but it may in fact be beneficial. Even more dramatically, the findings include that drinking coffee on a daily basis has the potential to cut the risk of AF by up to 40 per cent.
The DECAF clinical trial – kudos to the inventors of that acronym, ‘Does eliminating coffee avoid fibrillation’ – set out to establish whether the consumption of caffeinated coffee has any impact on the risk of AF episodes – good, bad, or indifferent. The multi-centre trial was randomised and involved 200 patients with current or previous (within the past five years) coffee-drinking adults with persistent AF, or atrial flutter with a history of AF, planned for electrical cardioversion from five hospitals in the US, Canada, and Australia between November 2021 and December 2024.
The authors concluded: “In this clinical trial of coffee drinkers after successful cardioversion, allocation to consumption of caffeinated coffee averaging one cup a day was associated with less recurrence of AF or atrial flutter compared with abstinence from coffee and caffeinated products.”
For those of you interested in how robust the data are, the study design was as follows: Two hundred patients (mean [SD] age, 69 [11] years; 71% male) were randomised to caffeinated coffee consumption (n = 100) or coffee abstinence (n = 100). Baseline coffee intake was seven cups (IQR, 7-18) per week in both groups. During follow-up, coffee intake in the consumption and abstinence groups was seven (IQR, 6-11) and 0 (IQR, 0-2) cups per week, respectively, resulting in a between-group difference of seven cups (95% CI, 7-7) per week. In the primary analysis, AF or atrial flutter recurrence was less in the coffee consumption (47%) than the coffee abstinence (64%) group, resulting in a 39 per cent lower hazard of recurrence (hazard ratio, 0.61 [95% CI, 0.42-0.89]; P = .01).
A comparable benefit of coffee consumption was observed with AF recurrence only, said the authors, and the primary end point was clinically detected recurrence of AF or atrial flutter over six months. There was no significant difference in adverse events, said the researchers.
“Coffee increases physical activity, which is known to reduce atrial fibrillation,” said Dr Gregory M Marcus, MD, Professor in Atrial Fibrillation Research and Electrophysiologist, University of California, San Francisco (UCSF) Health. Dr Marcus is the senior author of the paper, which appeared recently in JAMA. “Caffeine is also a diuretic, which could potentially reduce blood pressure and in turn lessen AF risk. Several other ingredients in coffee also have anti-inflammatory properties that could have positive effects.”
First author Dr Christopher X Wong, PhD, UCSF, and the University of Adelaide and Royal Adelaide Hospital, added: “The results were astounding. Doctors have always recommended that patients with problematic AF minimise their coffee intake, but this trial suggests that coffee is not only safe, but likely to be protective.”
As reported by your Dorsal View in May 2024, a 2010 BMJ study observed “doctors commonly use coffee as a stimulant. Substantial variation exists between specialties. Surgeons drink notably more coffee than physicians, with orthopaedic surgeons consuming the greatest amount in the communal cafeteria setting, though this might reflect social tendencies rather than caffeine dependency…. Hierarchical position is positively correlated with coffee consumption and generosity with regard to buying rounds of coffee.”
Ultimately, findings like those highlighted in the AF coffee study show how ongoing research continues to refine our understanding of everyday habits and what they mean for our health.
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