Does Eliminating Coffee Avoid Fibrillation? - DECAF
Contribution To Literature:
The DECAF trial demonstrated that patients with atrial fibrillation (AFib) who drank an average of 1 cup of coffee a day following successful cardioversion had fewer recurrences of AFib or atrial flutter compared with those who abstained from coffee.
Study Design:
DECAF was a prospective, open-label, multicenter (5 hospitals in U.S., Canada, and Australia), randomized controlled trial in which current or previous (within past 5 years) coffee-drinking adults with persistent AFib, or atrial flutter with a history of AFib, were randomized in a 1:1 ratio after sustained successful cardioversion to regular caffeinated coffee consumption vs. coffee and caffeine abstinence (100 patients in each group) for 6 months.
- Total number of enrollees: 200
- Duration of follow-up: 6 months
- Mean patient age: 69 years
- Demographics: 29% women, mean BMI 30.4 kg/m2; racial/ethnic distribution included White (82%), Asian (8%), Black (2%), Hispanic (10%)
Inclusion criteria:
- Adults ≥21 years of age with persistent AFib (or atrial flutter with a history of AFib) planned direct current electrical cardioversion
- Coffee consumption of ≥1 cup per day sometime in the past 5 years
- Willingness and ability to adhere to coffee abstinence or continuation
- Life expectancy ≥6 months
Exclusion criteria:
- Established or adverse reaction to coffee
- Stated inability to adhere to coffee abstinence or continuation
- AFib ablation or cardiothoracic surgery within 3 months
- Pregnancy or desire to conceive within 6 months
Other salient features/characteristics:
- Of 1,965 potential patients who were screened, 200 were randomized (one-quarter of patients screened not willing to abstain from coffee).
- Coffee consumption group was recommended to continue current consumption (not increase or decrease); abstinence group was encouraged to completely abstain from coffee/caffeine-containing products.
- Episodes of AFib or atrial flutter were confirmed by physician interpretation of an electrocardiogram (ECG), wearable ECG monitor, or implantable cardiac device electrograms.
- 16% had previous AFib ablation; 16% had prior physician advice to decrease coffee.
- 52% were taking antiarrhythmic medication; 93% were on anticoagulation.
- Mean left ventricular ejection fraction, 53.8%; mean left atrial volume index, 45.3 mL/m2.
Principal Findings:
Primary outcome:
- Recurrence of AFib or atrial flutter (≥30 seconds) in 6 months: 47% in the caffeinated coffee consumption group vs. 64% in the abstinence group (time to recurrence: hazard ratio [HR], 0.61 [95% CI, 0.42-0.89], p=0.01)
Secondary outcomes:
- Time to recurrence for AFib only: HR, 0.62 (95% CI, 0.43-0.91; p=0.01)
- Time to recurrence for atrial flutter only: HR, 0.37 (95% CI, 0.10-1.41; p=0.14)
- Adverse events before censorship: 13 emergency visits and 23 hospitalizations in coffee consumption vs. 16 emergency visits and 21 hospitalizations in coffee abstinence group
Safety outcomes:
- Adverse events were included in the secondary analysis; no deaths occurred in either group
Interpretation:
In this open-label, randomized clinical trial of previously coffee-drinking patients with persistent AFib undergoing cardioversion, consumption of caffeinated coffee compared with abstinence from coffee and caffeine was associated with a significantly lower recurrence of AFib or atrial flutter. Naturally occurring caffeine within normal ranges of consumption may have protective effects against the recurrence of AFib after cardioversion and help prevent further episodes.
References
Presented by Christopher X. Wong, MBBS, MPH, PhD, at the American Heart Association Scientific Sessions (AHA 2025), New Orleans, LA, Nov. 9, 2025.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: AHA Annual Scientific Sessions, AHA25, Arrhythmias, Cardiac, Secondary Prevention
