Tools for Practice Outils pour la pratique


#271 Be still my quivering heart: alcohol and atrial fibrillation


CLINICAL QUESTION
QUESTION CLINIQUE
Does advising patients to abstain from alcohol prevent atrial fibrillation recurrence?


BOTTOM LINE
RÉSULTAT FINAL
Observational studies consistently report a dose-response association between alcohol and new onset atrial fibrillation. Based on 1 randomized controlled trial (RCT) of “regular drinkers” with paroxysmal atrial fibrillation, recurrence of atrial fibrillation happened in ~50% who abstain compared to ~70% who continue drinking. Abstaining can prevent 1 atrial fibrillation-related hospital visit for every 9 people compared to those who continue to drink at 6 months. 



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EVIDENCE
DONNÉES PROBANTES
Open-label RCT in Australia, 140 patients with atrial fibrillation for ~6 years (mainly paroxysmal) and “regular” alcohol use (mean 16 per week). Mean age 62, 85% male, randomized to oral and written advice to abstain from alcohol with monthly follow-up and positive reinforcement or control (no advice on drinking). At 6 months:1 
  • Mean alcohol intake per week: 2 (intervention) versus 13 (control). 
  • Complete abstinence: 61% (intervention). 
  • Atrial fibrillation recurrence: 53% versus 73% (control), number needed to treat (NNT)=5. 
  • Atrial fibrillation-related hospital admissions: 9% versus 20% (control), NNT=9. 
  • Other benefits: 3.7kg weight loss in intervention. 
  • Limitations: 70% of patients screened for study not interested in abstinence; participants had to be in normal sinus rhythm at randomization. 
Best systematic reviews of observational studies on relationship between chronic alcohol use and new onset atrial fibrillation:2,3 
  • Risk differs between studies due to different populations, definitions of alcohol use, adjustment for confounders and whether results separated by gender. Best estimates: 
    • Compared to non or infrequent users (<2 drinks per month), the relative risk of atrial fibrillation appears to increase ~10% per drink per day.2 
    • Absolute risk (per 1000 patient years) over ~4.5 years: 
      • 15 for low (<1 drink/week), 17 for moderate (≤2 drinks/day for women and 3 for men) and 21 for high [>2 per day (women) or 3/day (men)].4 
Context: 
  • Older data suggests up to 35% of new cases of atrial fibrillation are related to acute alcohol intoxication,5 and may recur with subsequent binge drinking.6 
  • Guidelines recommend lifestyle interventions for atrial fibrillation, including weight loss, increasing physical activity, quitting smoking and reducing alcohol intake.7 


Gilbert Bretecher June 5, 2023

larger alcohol intake increases risk of AF


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Author(s)
Auteur(s)
  • Adrienne J Lindblad BSP ACPR PharmD
  • Michael R Kolber MD CCFP MSc

1. Voskoboinik A, Kalman JM, De Silva A, et al. New Engl J Med. 2020; 382:20-8.

2. Larsson SC, Drca N, Wolk A. J Am Coll Cardiol. 2014 Jul 22; 64(3):281-9.

3. Gallagher C, Hendriks JML, Elliott AD, et al. Int J Cardiol. 2017; 246:46-52.

4. Liang Y, Mente A, Yusuf S, et al. CMAJ. 2012 Nov 6; 184(16):E857-66.

5. Lowenstein SR, Gabow PA, Cramer J, et al. Arch Intern Med. 1983 Oct; 143(10):1882-5.

6. Krishnamoorthy S, Lip GYH, Lane DA. Am J Med. 2009; 122:851-6.

7. Chung MK, Eckhardt LL, Chen LY, et al. Circulation. 2020 Mar 9; CIR0000000000000748 [epub ahead of print].

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.