Should people with AF avoid coffee?

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Coffee is clearly an extremely popular beverage, and there is a huge body of evidence indicating that it has numerous health benefits. A recent study for example, found that drinking more than three cups of coffee every day, was associated with a 38% lower risk of all-cause mortality. 

And an umbrella review from 2107 in which researchers looked at 218 meta-analyses of both observational and interventional research with nine unique outcomes, identified the sweet spot for the largest risk reductions for the various health outcomes was three to four cups of coffee daily. 

Compound interest

Coffee contains over 1,000 bioactive compounds that provide antioxidant, anti-inflammatory, antifibrotic, and even anticancer effects. Key compounds include caffeine, chlorogenic acid, and the diterpenes cafestol and kahweol. 

Chlorogenic acid is the most abundant antioxidant in coffee, and although roasting degrades it, other antioxidant compounds are formed during the process. Caffeine also has notable antioxidant properties, while cafestol and kahweol exert anti-inflammatory effects. These combined actions likely explain many of coffee’s apparent health benefits. 

Despite this, medical advice has traditionally recommended limiting caffeinated coffee because of concerns about cardiovascular risk. But is this advice truly justified?

Heart of the matter

In 1963, a longitudinal study of men aged 40–55 years reported a significant positive correlation between coffee consumption and coronary heart disease (CHD) incidence. One explanation for this relationship is because the caffeine is a stimulant, so it raises the heart rate and in turn triggers arrhythmias. 

One of the most common, global arrhythmias is atrial fibrillation (AF), characterized by an irregular, often rapid heart rate and which can present as paroxysmal, persistent (lasting more than seven days), or permanent. 

Symptoms typically include palpitations, dizziness, dyspnoea, and fatigue. In the UK, AF affects approximately 1.7 million people and accounts for up to 30% of ischemic strokes.

The belief that coffee worsens AF is prevalent among both clinicians and patients. A 1988 survey found that over 75% of physicians advised reducing caffeine intake for patients with palpitations. Similarly, patient perceptions align with this view; in one study, 25% of individuals with paroxysmal AF identified coffee as a trigger. But is there objective evidence to show that coffee exacerbates AF? 

Is coffee proarrhythmogenic?

The effect of coffee on AF can be assessed through measurement of premature atrial contractions, as these are known to initiate paroxysms of AF. In one such study of nearly 1,400 older adults, using 24-hour ambulatory electrocardiography (EGC), researchers were unable to find a relationship between any level of coffee intake and premature atrial contractions. 

A more recent randomised trial in 2023, again found no difference in premature atrial contractions, on days when participants drank coffee compared to when they abstained from the drink.  

One final way to assess if coffee is proarrhythmogenic, would be to determine whether the drink induces a recurrence of AF in those having undergone cardioversion (i.e. to restore sinus rhythm). This was the question addressed in a recent, randomised trial.

The DECAF trial

The DECAF (Does Eliminating Coffee Avoid Fibrillation?) trial was published in JAMA in November 2025. The study enrolled patients with sustained AF who underwent cardioversion to restore sinus rhythm. A total of 200 patients who underwent the procedure were split into two groups: coffee drinkers and coffee abstainers. 

Those assigned to coffee were encouraged to drink at least 1 cup of caffeinated coffee (or at least 1 espresso shot) and other caffeine-containing products every day as per their usual lifestyle. The abstainers were encouraged to completely abstain from both caffeinated and decaffeinated coffee and other caffeine-containing products.

Both groups were then followed for 6 months, and the main outcome of interest was the recurrence of AF lasting at least 30 seconds or longer and confirmed by ECG. Those in the coffee group consumed roughly one cup of per day during the 6-month follow-up period. At the study end, there was a 39% lower risk of developing AF in the coffee group. 

Advice for patients

The DECAF trial suggests that following cardioversion, there is a significantly lower risk of AF recurrence in coffee drinkers. 

According to their website, the British Heart Foundation, says that caffeine is not a cause of AF but accepts that individuals may find that it worsens palpitations. The most recent European guidelines on AF management recognise that caffeine is a risk factor for new onset AF but accept there is a lack of clarity as to whether this relationship is in fact causal. 

In contrast, US guidelines are more direct in stating that ‘recommending caffeine abstention to prevent AF episodes is of no benefit, although it may reduce symptoms in patients who report caffeine triggering or worsening AF symptoms. 

To date there have been several meta-analyses of observational studies which suggest that drinking coffee reduces the risk of AF. Consequently, it is difficult to provide any firm recommendations for patients. 

Factors such as how the coffee is prepared (e.g. boiled, filtered) may influence the purported health benefits. So, while a coffee a day won’t keep AF completely at bay, it does seem to reduce the risk of recurrence, hence the advice to avoid coffee might need to be reconsidered.