Randomized trial shows coffee lowers AF recurrence after cardioversion
AHA 2025 – In DECAF among patients with a history of AF who had undergone successful cardioversion, drinking ≥1 cups of coffee decreased the risk of AF or atrial flutter at 6 months compared with caffeine abstinence, with no increase in adverse events.
This summary is based on the presentation of Christopher Wong, PhD (Adelaide, Australia) at the AHA Scientific Sessions 2025 - The Does Eliminating Coffee Avoid Fibrillation (DECAF) Trial.
Introduction and methods
Multiple observational studies have shown the consumption of coffee reduces the incidence of AF or has no effect on this risk. On the other hand, a recent analysis of Multi-Ethnic Study of Atherosclerosis data suggested an increased AF risk with higher coffee intake. Yet, randomized study data are lacking.
In the DECAF (Does Eliminating Coffee Avoid Fibrillation?) trial, a multinational RCT, 200 patients (aged ≥21 years) with a history of AF who had undergone successful cardioversion for AF or atrial flutter were included. They were randomized to either consumption of ≥1 cups of caffeinated coffee per day or abstinence from coffee and caffeine-containing products for 6 months. Participants had to have drunk ≥1 cups of coffee per sometime in the previous 5 years.
The primary endpoint was clinically-detected recurrence of AF or atrial flutter lasting ≥30 s, at 6 months. Secondary endpoints were the separate recurrence of AF or atrial flutter and the incidence of adverse events, including MACE, emergency room visits, hospitalizations, and death.
Main results
- In the primary intention-to-treat analysis, which included all study participants regardless of compliance, the primary endpoint occurred in 47% of the patients who were assigned to the coffee consumption arm (n=100) and 64% of those in the coffee and caffeine abstinence arm (n=100) (HR: 0.61; 95%CI: 0.42–0.89; P=0.01).
- Similar results were seen for the rate of recurrent AF only (HR: 0.62; 95%CI: 0.43–0.91; P=0.01) and in the prespecified as-treated analysis based on actual coffee consumption (HR: 0.53; 95%CI: 0.36–0.78; P=0.002).
- There was no difference in the frequency of adverse events between the 2 groups.
Conclusion
In this RCT among coffee drinkers with a history of AF who had undergone successful cardioversion, caffeinated coffee consumption was associated with a lower recurrence rate of AF or atrial flutter at 6 months compared with caffeine abstinence, with no increase in adverse event rate.
- Our reporting is based on the information provided at the AHA Scientific Sessions 2025 and publication of the data in JAMA -