Counsel patients with paroxysmal or persistent atrial fibrillation (AF) who drink moderately ([greater than or equal to] 10 drinks per week) that they can reduce their time in AF, as well as their overall recurrence of AF, by decreasing their alcohol consumption by half or more.
STRENGTH OF RECOMMENDATION
B: Based on a well-performed randomized controlled trial (1)
Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med. 2020;382:20-28.
A 61-year-old man with hypertension and paroxysmal AF presents to your office shortly after experiencing his third episode of AF in the past 6 months. He describes these episodes, which last for several days, as "just awful," noting that when he experiences AF, he has fatigue, palpitations, and shortness of breath and "can't stop paying attention to my heart." The patient, who has a body mass index of 32, consumes more than 15 alcoholic drinks per week. What can you recommend to him that will decrease his likelihood of experiencing more episodes of AF?
AF is the most common sustained cardiac arrhythmia. It is associated with significant morbidity and mortality. Known risk factors include obesity, physical inactivity, sleep apnea, diabetes, and hypertension. (2)
According to the Centers for Disease Control and Prevention, an estimated 12.1 million people in the United States will have AF by 2030. In 2018, AF was mentioned on more than 183,000 death certificates and was the underlying cause of more than 26,000 of those deaths. (3) AF is the primary diagnosis in 450,000 hospitalizations annually, (4) and the death rate from AF as the primary or contributing cause of death has been rising for more than 2 decades. (3)
More than 50% of Americans report alcohol consumption within the past month. (5) Although alcohol use is associated with new and recurrent AF, only limited prospective data show a clear and causal association between abstaining from alcohol and decreasing AF recurrence.
Reduction in AF recurrence and total AF burden following alcohol abstinence
This multicenter, prospective, open-label, randomized controlled trial (N = 140) from 6 sites in Australia evaluated the impact of alcohol abstinence on both the recurrence of AF and the...