DECAF Trial Report: Coffee Consumption and AFib Recurrence

Arrhythmia News article

Caffeine intake has long been debated in atrial fibrillation (AFib) management, with observational evidence suggesting both potential harm and benefit. The DECAF (Drink Coffee After Fibrillation) randomized clinical trial directly tested whether moderate coffee consumption after cardioversion influences AFib or atrial flutter recurrence.

Amina Rakisheva
Amina Rakisheva
Cardiologist
Kazakhstan

Study Design

  • Population: 200 patients with persistent AFib or atrial flutter (with history of AFib), post-successful electrical cardioversion.
  • Sites: United States, Canada, Australia.
  • Intervention: Randomization to either:
    • Caffeinated coffee consumption: ≥ 1 cup/day
    • Coffee/caffeine abstinence: for 6 months
  • Baseline: Participants were habitual coffee drinkers (~ 7 cups/week).
  • Follow-up: 6 months after cardioversion.

Key Findings

  • Recurrence of AFib or Atrial Flutter:
    • Coffee group: 47%
    • Abstinence group: 64%
    • This corresponds to a lower recurrence rate among coffee consumers (Kaplan–Meier curves confirm significant separation between groups)
DECAF Trial Report: Coffee Consumption and AFib Recurrence, figure 2

 

  • Safety: No increase in adverse events, arrhythmia burden, or hospitalizations between groups.

Interpretation

“Caffeinated coffee may not increase AFib risk and may even reduce it,” stated Gregory M. Marcus, MD, MAS, FACC, senior author.

“Clinicians can reasonably allow patients to enjoy caffeinated beverages, while acknowledging that individual sensitivity to caffeine varies.”

Limitations

Included only current or prior coffee drinkers; results cannot be extrapolated to caffeine-naïve individuals.
Dose limitation: Findings apply to ~ 1 cup/day, not to high consumption or to energy drinks.
Short duration: Six-month follow-up; long-term effects unknown.

Conclusions

Moderate daily coffee consumption (≈ 1 cup/day) following cardioversion was associated with fewer AFib recurrences compared with caffeine abstinence, with no safety signal detected.
These findings challenge traditional recommendations to avoid caffeine in AFib patients and suggest a need for personalized, evidence-based counseling on caffeine use.