Research Summary

Caffeinated Coffee Linked to Lower Risk of Recurrent Atrial Fibrillation: The DECAF Randomized Trial

Edited by:
Ashton L. Stahl

Key Highlights:

  • In the DECAF randomized trial, 200 adults with persistent atrial fibrillation (AF) were assigned to either daily caffeinated coffee or caffeine abstinence.
  • The recurrence of AF or atrial flutter occurred in 47% of the coffee group vs 64% of the abstinence group over 6 months.
  • Coffee consumption was associated with a statistically significant 39% lower risk of AF recurrence.
  • No difference in adverse events was observed between groups.

Although clinicians have cautioned patients with arrhythmias to avoid caffeine, new evidence published in JAMA challenges that perception, suggesting potential benefits of moderate coffee consumption for heart rhythm stability. The DECAF (Does Coffee Affect Atrial Fibrillation) randomized clinical trial examined the relationship between caffeinated coffee consumption and recurrent atrial fibrillation (AF) after successful cardioversion.

This prospective, open-label, multicenter trial enrolled 200 adults aged 21 years and older with a history of coffee drinking and persistent AF, or atrial flutter with a history of AF, across 5 hospitals in the United States, Canada, and Australia. Participants were randomized 1:1 to consume at least 1 cup of caffeinated coffee daily or abstain completely from coffee, caffeine-containing beverages, and decaffeinated coffee. The study’s primary endpoint was the recurrence of clinically detected AF or atrial flutter within 6 months following cardioversion.

Study Findings

At baseline, both groups reported similar coffee intake, averaging 7 cups per week. During follow-up, the coffee group maintained a median weekly intake of 7 cups, while the abstinence group consumed none. Over 6 months, AF or atrial flutter recurred in 47 of 100 participants in the coffee group compared with 64 of 100 in the abstinence group, a statistically significant difference favoring coffee consumption.

The hazard ratio for recurrence was 0.61 (95% CI, 0.42–0.89; P = .01), corresponding to a 39% lower risk of recurrent arrhythmia. Rates of hospitalization, heart failure, or stroke did not differ significantly between groups. Secondary outcomes mirrored the primary findings, with isolated AF recurrence also lower in the coffee group.

Clinical Implications

According to the study authors, the findings suggest that daily caffeinated coffee consumption may be reasonably considered in patients with atrial fibrillation following cardioversion. The data challenge longstanding assumptions that caffeine increases arrhythmic risk and underscore the potential for individualized recommendations rather than blanket avoidance. However, the authors caution against interpreting results given the open-label design, modest sample size, and limited arrhythmia-detection methods.

Expert Commentary

“Consumption of coffee and other caffeinated products may be reasonably considered in patients with atrial fibrillation,” the researchers concluded.

Reference

Wong CX, Cheung CC, Montenegro G, et al. Caffeinated coffee consumption or abstinence to reduce atrial fibrillation: the DECAF randomized clinical trial. JAMA. Published online November 9, 2025. doi:10.1001/jama.2025.21056