#3-37E. Brewing Controversy: The DECAF Trial on Coffee and AF Recurrence (JAMA, 2026)

Do you routinely advise patients with atrial fibrillation to abstain from caffeine to prevent arrhythmias? In this episode, we analyze the DECAF trial, a pivotal randomized clinical study that challenges this longstanding dogma. The investigators enrolled 200 patients with persistent AF scheduled for electrical cardioversion, randomizing them to either regular caffeinated coffee consumption or complete abstinence for six months. Strikingly, the study found that patients allocated to coffee consumption experienced a significantly lower incidence of recurrent AF or atrial flutter compared to the abstinence arm (47% vs. 64%), translating to a hazard ratio of 0.61. While the open-label design warrants caution regarding potential bias in symptom reporting and behavioral changes, the data strongly suggest that caffeine—potentially via adenosine receptor blockade—may actually stabilize cardiac rhythm rather than disrupt it. For the practicing physician, this evidence supports a paradigm shift: rather than prohibiting coffee, allowing moderate consumption could be a reasonable, evidence-based approach to improving quality of life and potentially reducing recurrence in AF patients.

Citation: Wong CX, et al. Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation. JAMA. 2026. DOI: 10.1001/jama.2025.21056

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