NEW ORLEANS — Cutting down on booze allowed patients to reduce their atrial fibrillation (Afib) burden and recurrence rates, according to the first randomized trial to test what alcohol does in this population.
Going from more than two drinks a day on average to about two a week, Afib patients asked to abstain had mean recurrence-free survival time of 118 days versus 86 in a control group (log-rank P=0.004), Aleksandr Voskoboinik, MBBS, of Australia’s Alfred Hospital in Melbourne.
After 6 months, 73% of controls suffered Afib recurrence (one of the study’s two primary endpoints) compared with 53% of the abstinence group.
Alcohol abstinence was also tied to reduced time spent in Afib over 6-month follow-up (median 0.5% vs 1.2%, P=0.016), which was the other primary endpoint, Voskoboinik showed here at the American College of Cardiology’s annual conference.
“Significant reduction in alcohol intake should be part of the lifestyle intervention in moderate drinkers with Afib,” the presenter concluded, adding that abstinence was also associated with reduced blood pressure, weight, and BMI.
Until this study, randomized trial data was notably lacking in the field, many noted.
“What we largely don’t have are experiments — actual trials where alcohol intake is intervened upon. The reason for that is complicated but the reality is that we don’t have gold-standard evidence on the health effects of alcohol,” said Kenneth Mukamal, MD, MPH, of Beth Israel Deaconess Medical Center in Boston, who was not involved with the trial.
Voskoboinik’s group performed their open-label multicenter trial with 140 patients presenting with paroxysmal or persistent Afib who drank ten or more alcohol drinks per week (but were not dependent on alcohol nor had a psychiatric comorbidity).
The average ended up being 16 drinks per week in both groups (about two-thirds being wine).
At 1:1 randomization to alcohol abstinence of usual drinking, all were in sinus rhythm and on stable medical therapy. Mean age was around 62 years and over 80% of participants were men. CHA2DS₂-VASc scores averaged about 1.5. Some imbalances between cohorts were noted, including that the control group had more patients with previous Afib ablation (35.7% vs 28.6%) and an existing pacemaker or loop recorder (38.6% vs 32.9%).
Only 61.4% of the abstinence group truly kept away from alcohol. Patients in that arm underwent urine testing for alcohol metabolites and were contacted monthly for positive reinforcement.
Rhythm monitoring was achieved with an existing implantable loop recorder or pacemaker among patients who had these devices; others used smartphone-based AliveCor ECGs and Holter monitoring. Events were adjudicated by blinded cardiologists. Afib recurrence was defined as any atrial tachyarrhythmia lasting at least 30 seconds.
More alcohol-abstaining patients had zero or mild Afib symptoms over follow-up (90% vs 68%, P<0.05) and abstinence was the only negative predictor of Afib recurrence on multivariate analysis (HR 0.52, 95% CI 0.30-0.89). Abstinence also appeared to benefit patients on secondary outcomes, including blood pressure and body weight.
Voskoboinik noted that the study had to be shortened from 12 months to 6 months to make it easier to find participants willing to abstain from alcohol.
“While this study was quite small and largely involved above-recommended drinkers (even the average intake was above U.S. recommendations — ‘moderate’ in the title is at best a judgment call), it’s nice to see actual trial evidence,” Mukamal maintained.
“It’s noteworthy that in the U.S., many of these patients would be taking blood thinners for which the NIAAA [National Institute on Alcohol Abuse and Alcoholism] recommends no alcohol consumption already, so again the utility may be somewhat limited in scope, but it’s a nice step forward.”
“I think you know how many times in medicine we think we know something because it makes sense, but it turns out to not be correct,” Vivek Reddy, MD, of The Mount Sinai Hospital in New York City, told MedPage Today. “So from what I can see, this seems to be a well-designed study with a fairly unequivocal outcome. And I think it does add definitively to our scientific knowledge base.”
Voskoboinik reported support from an Australian National Health and Medical Research Council and National Heart Foundation scholarship, a Baker Research Institute Bright Sparks scholarship, and a CSANZ Travelling Fellowship.