Dr Richard Bogle PhD FRCP FESC FACC DHMSA
Consultant Cardiologist
  • Home
  • NHS Practice
    • NHS Practice
    • St Helier Hospital
    • Epsom Cardiac Day Unit
    • St George's Hospital Radial Lounge
    • Echocardiography
  • Biography
    • Qualifications
    • About me >
      • Curriculum vitae
    • Appraisal and Revalidation
    • BCIS Angioplasty Audit
    • Publications
    • Recent abstracts
    • Research
    • Charitable activity
  • The Heart
    • Cardiac Investigations >
      • AliveCor ECG monitor
      • Guide to investigations for suspected angina
      • CT calcium scoring
      • Electrocardiogram (ECG)
      • Exercise treadmill test
      • Echocardiogram
      • Valve disease
      • Coronary Angiography
      • Pressure Wire Studies
      • Intra-vascular Ultrasound
    • Arrhythmias >
      • Atrial fibrillation >
        • Stroke Risk in AF
        • New Oral Anticoagulants
        • Presentations on AF
      • Atrial flutter
      • Pre-excitation syndromes
      • Ventricular ectopic beats
      • Ventricular arrhythmias
      • Pacemaker
      • DC Cardioversion
    • Cardiomyopathy
    • Coronary heart disease >
      • Cardiac syndrome X
      • Coronary Angioplasty
      • Coronary bypass surgery
    • Dizziness and blackouts
    • Fitness to fly
    • Fitness to drive
    • Heart Failure
    • Hypertension >
      • Patients guide to blood pressure medication
      • Home blood pressure monitors
      • Hypertension diet
      • Laragh's method
      • Renal sympathetic ablation for hypertension
      • Conn's Syndrome
    • Heart Screening >
      • Sports Cardiology
      • Cardiovascular Disease Risk
    • Medications >
      • Glyceryl trinitrate
    • Patient information leaflets
  • News and Links
  • Miscellany
    • History of Medicine
    • History of Coronary Angiography and Angioplasty
    • Stamps in Cardiology
    • A History of Medicine in 100 Objects
    • BSE Acceditation Course Introduction
    • BSE Acceditation Course Physics
    • BSE Acceditation Course Anatomy and Function
    • BSE Acceditation Course Mitral
    • BSE Acceditation Course Aortic
    • BSE Acceditation Course Congenital
    • BSE Acceditation Course Pericardium
  • Blog
  • RACPC Form
  • Cardiology Teaching St Helier Hospital

Why giving up coffee won't help your palpitations

26/5/2015

2 Comments

 
When a patient complains of palpitations and a diagnosis of atrial or ventricular ectopic beats is made the cardiologist's recommendation usually starts with some lifestyle advice such as avoiding caffeine. Since these tea and coffee are often an integral part of our daily routine you might ask; What is the evidence for this recommendation and is it effective?  Limiting caffeine consumption forms part of common medical advice. In one study of 697 medical specialists surveyed about caffeine >75% recommended caffeine reduction for patients with anxiety, arrhythmias, oesophagitis/hiatus hernia insomnia, palpitations, and tachycardia.

A recent poster at the Heart Rhythm Society meeting looked at the database of the Cardiovascular Health Study. This study began in 1989 and has followed more than 5000 patients aged 65 years or over. The researchers measured the number of atrial and ventricular ectopic beats in 1414 individuals randomly assigned to have 24h tapes fitted. Then they looked at the results of self-reported food frequency questionnaires and determined whether there was any association between the amount of caffeine consumption and the number of ectopic beats. In a nutshell, there was none and therefore in an asymptomatic group of older patients ectopic frequency is not linked to caffeine intake. 

However these were asymptomatic people and perhaps in folk with palpitations caffeine withdrawal might just improve symptoms. If you search the medical literature for "caffeine" and "palpitations" you will find only a single study which has looked at this question. The researchers entered 13 patients in a randomised, double blind, 6 week intervention trial of dietary caffeine restriction, caffeinated coffee, and decaffeinated coffee measuring caffeine levels in the blood, a visual analogue score of palpitations and 24 hour ventricular premature beat frequency. Their interventions significantly reduced serum caffeine concentrations. The palpitation scores showed a small, but significant correlation with ventricular premature beat frequencies (r = 0.34) but there were no significant changes in palpitation scores or ventricular ectopic beat frequencies during the intervention weeks and no correlations between these variables and serum caffeine concentrations. The authors concluded that caffeine restriction has no role in the management of patients referred with symptomatic idiopathic ventricular premature beats.

So it seems at least as far as ventricular ectopic beats are concerned our advice to reduce caffeine consumption with the aim of improving symptoms is no founded on any evidence. For my own patients I usually say that if they want to give up tea or coffee for 2 weeks and review their symptoms that is fine. If the intervention subjectively makes a substantial improvement to how they feel then continue off the caffeine, otherwise go back to your normal regime. It is interesting that such commonly given advice is founded on such a weak evidence base.

2 Comments
Lauren link
24/6/2015 07:04:35 am

Great post! I agree with the way you are using these finding with your patients. I think giving up coffee or tea for 2 weeks and then reviewing their symptoms is a smart idea. Thanks for sharing!

Reply
terry
23/9/2015 01:49:19 pm

i like your blog. i find it interesting both as a cardio patient and psychometrician interested in the evidential basis for educational interventions.

i have a lot of respect for doctors and appreciate all the hard work and study you have done for what must be a stressful job.

keep up the good work, man!


vancouver, canada

Reply

Your comment will be posted after it is approved.


Leave a Reply.

    RSS Feed

    Picture

    Dr Richard Bogle

    The opinions expressed in this blog are strictly those of the author and should not be construed as the opinion or policy of my employers nor recommendations for your care or anyone else's. Always seek professional guidance instead.

    Archives

    November 2019
    March 2016
    February 2016
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    November 2013
    October 2013
    August 2013
    July 2013
    June 2013
    May 2013
    April 2013
    March 2013
    February 2013
    January 2013

    Categories

    All
    Ablation
    Acute Coronary Syndromes
    Acute Coronary Syndromes
    Adherence
    Angioplasty
    Anticoagulants
    Arrhythmia
    Association
    Atherosclerosis
    Atrial Fibrillation
    Auenbrugger
    Bergamot
    Brugada
    Calcium Channel Blockers
    Cancer
    Cardiovascular Risk
    Chest Pain
    Cholesterol
    Cleveland Street
    Clinical Examination
    Colchicine
    Compliance
    Concordance
    Congenital Heart Disease
    Coronary Artery Disease
    Coronary Artery Disease
    C-reactive Protein
    Decision Aids
    Diet
    Ectopics
    Eggs
    Ezetimibe
    Frailty
    Frank's Sign
    Guidelines
    Hawthorne Effect
    Heart Failure
    History Of Medicine
    Hypertension
    ICD
    Internet
    Interventional Cardiology
    Joseph Rogers
    Lipids
    Malaria
    Marathon
    Medicines
    Nice Guidelines
    Nitrovasodilators
    NOAC
    Nudge
    Nutrition
    OCT
    Palpitations
    Pharmacy
    Pressure Wire
    Proteus
    Salt
    Smoking
    Spironolactone
    Statins
    Statistics
    Stent
    Stress
    Stroke
    Syndrome X
    Takotsubo
    Valve-disease
    Vein Grafts
    Ventricular Ectopics
    VF/VT
    Warfarin
    Weekend Working
    Workhouse

    View my profile on LinkedIn
Return to home page

Privacy Statement
Disclaimer
© Dr Richard Bogle 2020
patient feedback
Photo used under Creative Commons from peddhapati