Key Points
- The Does Eliminating Coffee Avoid Fibrillation (DECAF) trial is the first randomized study to directly test whether coffee consumption influences atrial fibrillation (AF) recurrence.
- Among 200 patients post-cardioversion, habitual coffee drinkers had 39% fewer recurrences of AF or flutter compared with those abstaining (HR 0.61, 95% CI 0.42–0.89; p=0.010).
- The benefit persisted across most subgroups, with no increase in adverse events, hospitalizations, or mortality.
For decades, patients and clinicians alike have believed that caffeine triggers atrial fibrillation. Nearly one in four patients reports coffee as a personal AF trigger, and Current guidelines still suggest that caffeine abstinence may reduce symptoms. Yet Observational studies have often shown neutral or even protective effects.
At the 2025 American Heart Association Scientific Sessions, Dr. Christopher X. Wong presented the DECAF Trial (NCT05121519), an investigator-initiated, international, multicenter randomized study simultaneously published in JAMA (November 9, 2025).
The trial tested the effect of caffeinated coffee consumption compared with abstinence from coffee and caffeine on recurrent AF. DECAF enrolled adults (≥21 years) with sustained AF or flutter scheduled for successful electrical cardioversion. Eligible participants reported at least one cup of coffee per day in the past five years and were willing to either continue or abstain from coffee for six months. Two hundred patients were randomized 1:1 to either continue caffeinated coffee (≥1 cup per day) or abstain completely from coffee and all caffeine-containing products. The primary endpoint was any clinically detected or device-recorded recurrence of AF or atrial flutter lasting ≥30 seconds within six months of cardioversion. Participants had a mean age of 69 ± 11 years and baseline CHA₂DS₂-VASc scores averaged 2.5. Baseline cardiovascular risk factors were well balanced between groups.
At six months, AF or flutter recurred in 47% of the coffee group vs 64% of the abstinence group, yielding a 39% lower hazard of recurrence with coffee (HR 0.61, 95% CI 0.42–0.89; p=0.010). In a pre-specified as-treated analysis, maintaining any coffee intake was associated with a 47% lower hazard (HR 0.53, 95% CI 0.36–0.78; p=0.002). Results were consistent across nearly all predefined subgroups, except for participants who had previously undergone AF ablation (interaction p=0.04). There were no significant differences in major adverse cardiac events, hospitalizations, or death
between the two randomized groups. Overall, the findings from this investigator-initiated trial demonstrated that the risk of recurrent AF was significantly lower in the group allocated to coffee consumption (47%) compared with the abstinence group (64%).
The DECAF Trial provides the first randomized evidence to challenge long-standing clinical guidance discouraging caffeine use in patients with AF. Dr. Wong and colleagues conclude that “random allocation to caffeinated coffee consumption resulted in less atrial fibrillation and flutter compared to abstinence from coffee and caffeine.
