Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation: The DECAF Randomized Clinical Trial

The DECAF randomized clinical trial investigated whether caffeinated coffee influences the recurrence of atrial fibrillation (AF) after cardioversion. Two hundred patients with persistent AF were randomized to either continue consuming caffeinated coffee (≥1 cup daily) or abstain entirely for six months. AF or atrial flutter recurred in 47 percent of coffee drinkers compared to 64 percent of abstainers, corresponding to a 39 percent lower recurrence risk (HR 0.61; 95 percent CI 0.42–0.89; P = .01). Secondary analyses showed similar trends for AF alone. No differences were seen in adverse events. Contrary to longstanding assumptions, moderate caffeinated coffee intake was associated with a reduced risk of AF recurrence. Proposed mechanisms for this effect include adenosine receptor antagonism, anti-inflammatory effects, and enhanced physical activity.