Coffee Does Not Increase Atrial Fibrillation Risk
The most recent and highest-quality randomized controlled trial (DECAF, 2025) definitively demonstrates that caffeinated coffee consumption does not increase AF risk and actually reduces AF recurrence by 39% compared to abstinence in patients with established AF. 1
Key Evidence from the DECAF Trial
The DECAF randomized clinical trial published in JAMA (2025) provides the strongest evidence available:
- 200 patients with persistent AF or atrial flutter were randomized to either regular caffeinated coffee consumption (≥1 cup daily) versus complete coffee and caffeine abstinence for 6 months 1
- AF/atrial flutter recurrence occurred in 47% of coffee consumers versus 64% in the abstinence group, representing a 39% lower hazard of recurrence (HR 0.61,95% CI 0.42-0.89, P=0.01) 1
- No significant difference in adverse events was observed between groups 1
This directly contradicts the conventional wisdom that caffeinated coffee is proarrhythmic 1
Supporting Observational Evidence
Multiple large prospective cohort studies reinforce these findings:
- The Swiss-AF and Beat-AF cohorts (2024) analyzed AF patients and found daily coffee consumption associated with 23% lower hazard for major adverse cardiovascular events (HR 0.77,95% CI 0.66-0.89) 2
- Moderate consumption of 2-3 cups daily showed the greatest benefit (HR 0.74,95% CI 0.63-0.87) compared to non-daily consumption 2
- A 2022 dose-response meta-analysis of 10 prospective studies (723,825 participants, 30,169 AF events) found each additional cup of coffee per day associated with 2% reduced AF risk (RR 0.98,95% CI 0.97-1.00) 3
Dose-Response Relationship
The evidence demonstrates a protective dose-response pattern:
- No increased AF risk was found when comparing <2 cups daily versus higher consumption (RR 1.068,95% CI 0.937-1.216) 4
- Lower AF incidence was observed among people consuming >436 mg caffeine daily (approximately 3+ cups) 4
- The dose-response curve shows progressive risk reduction up to 7 cups daily, though the relationship becomes less statistically robust at very high intakes 3
Clinical Implications for Cardiovascular Patients
Recent studies specifically demonstrate that regular coffee consumption decreases the risk of developing hypertension, heart failure, and atrial fibrillation 5
For patients with established cardiovascular disease:
- Daily coffee consumption in AF patients was associated with reduced risk for hospitalization for acute heart failure and all-cause mortality 2
- The analysis found no evidence of unfavorable associations between daily coffee consumption and adverse outcomes in AF patients 2
Guideline Context on AF Risk Factors
While current guidelines extensively discuss modifiable AF risk factors, they focus on:
- Alcohol intake reduction, particularly for heavy drinkers (>60 g/day for men, >40 g/day for women), which is associated with lower AF incidence 6
- Moderate physical activity reduces new-onset AF risk, though high-intensity endurance training may increase AF risk 2.5-fold 6
- Management of hypertension, heart failure, obesity, and sleep apnea as critical interventions for AF prevention 6
Notably, coffee consumption is not listed among risk factors requiring modification in the 2024 ESC Guidelines or other major AF management guidelines 6
Critical Clinical Pitfall to Avoid
Do not advise AF patients to avoid coffee based on outdated concerns about arrhythmia provocation. The highest-quality randomized evidence demonstrates the opposite effect, and unnecessarily restricting coffee may eliminate a beverage associated with cardiovascular benefits 1. The conventional wisdom that caffeine triggers AF is not supported by contemporary evidence 1.