The Effects of Caffeine

Whether the provision of caffeinated drinks should be encouraged in the Emergency Department of Premiere Hospital of Newport Beach?
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Abstract
Coffee is one of the most popular beverages all across the globe. The active ingredient in coffee is caffeine, which is a legalized and unregulated psychoactive substance in the world. Different studies suggest that consumption of caffeine might increase in systolic blood pressure and heart rate in healthy volunteers. This is because caffeine causes vasoconstriction of vascular smooth muscles and stimulates b2-adrenergic receptors of the heart. Likewise, the hospital authorities of Premiere Hospital of Newport Beach (PHNB) were exploring the possibilities of replacing or withdrawing the provision of caffeinated drinks from the OPDs for ensuring patient safety. The hospital authorities randomly collected data from 21 patients belonging to different age groups who awaited clinical consultation in the emergency department (ED) of PHNB. The respective individuals consumed caffeinated drinks at three different times of a day. The hospital authorities assessed the heart rate before and after the consumption of caffeinated drinks across concerned stakeholders. The study reflected that caffeinated drinks increase heart rate in concerned stakeholders and such increase is dependent on their resting heart rate. However, the presence of underlying cardiovascular disorders across the study participants could have confounded the findings of the present study.

Future studies should try to eliminate the confounding effects of blood pressure, age, and ethnicity to ensure improved reproducibility of the findings. Hence, the present report reflected that it would be wise for the management of PHNB to discourage the provision of caffeinated drinks in the ED.
Keywords: coffee, caffeinated drinks, PHNB, heart rate, emergency department
Whether the provision of caffeinated drinks should be encouraged in the Emergency Department of Premiere Hospital of Newport Beach?
Part 1: Primary Data Analysis
Coffee is one of the most popular beverages all across the globe. The active ingredient in coffee is caffeine, which is a legalized and unregulated psychoactive substance in the world. Chemically, caffeine is a 1, 3, 7-trimethyl xanthene and bears a molecular weight of 194.19gram/mole. Like other xanthenes, caffeine is well-known for its antioxidant properties and is indicated across patients suffering from various diseases such as COPD, diabetes mellitus, atherosclerosis, and ulcerative colitis. However, caffeine is the potent inhibitor of adenosine receptors on the endothelium of blood vessels. Hence, it antagonizes the actions of adenosine and causes vasoconstriction in systemic blood vessels. On the other hand, caffeine enhances the formation of angiotensin-II, catecholamines, and epinephrine. As a result, consumption of caffeine might be associated with an increase in systolic blood pressure and heart rate. Catecholamines and epinephrine increase the heart rate by stimulating the beta-2 adrenergic receptors (present in the myocardium), while it acts on the alpha-1 adrenergic receptors of the smooth muscles of the blood vessels to cause vasoconstriction. Angiotensin-II increases the secretion of aldosterone from the adrenal glands (adrenal cortex), which enhances sodium reabsorption from the renal tubules. Increased reabsorption of sodium increases the blood volume, which together with vasoconstriction, accounts for the rise in systolic blood pressure (Csiky & Simon, 1997). Hence, it is speculated that caffeine could have negative outcomes in patients suffering from hypertension or other cardiovascular disorders.
In one study, Geethavani, Rameswarudu & Reddy (2014) explored the effects of caffeine on the heart rate and blood pressure across healthy male volunteers belonging to the age group of 19 to 22 years. The study was conducted as a randomized controlled trial, and the experimental group was administered caffeine at a dose of 5mg/kg of their body weight. Geethavani et al. (2014) showed that administration of caffeine increased the systolic blood pressure and heart rate in the study participants by 17% and 6% respectively. The authors contended that caffeine increased the stiffness of aortic walls by stimulating the release of Angiotensin-II. This is because Angiotensin-II causes vasoconstriction and increases the peripheral resistance. The Geethavani et al. (2014) study implicated that caffeine might be contraindicated in patients suffering from cardiovascular disorders.
Different hospitals and healthcare organizations arrange various provisions of hospitality for patients and other visitors who await clinical consultation in the outpatient departments. Caffeinated beverages such as coffee or tea are one such popular provision that is routinely consumed by the respective stakeholders. However, some of these patients may have an underlying or confirmed cardiovascular disorder. Hence, provision of caffeinated drinks in hospital OPDs may cause complications in at-risk individuals. Likewise, the hospital authorities of Premiere Hospital of Newport Beach (PHNB) were exploring the possibilities of replacing or withdrawing the provision of caffeinated drinks from the OPDs for ensuring patient safety. At the preset moment, the hospital authorities of the PHNB hospital are primarily concerned with ensuring the safety of their patients. Although similar healthcare organizations serve coffee, tea, water, and other beverages to their patients and visitors, the PHNB authorities wanted to determine whether caffeinated drinks should be provided in the OPDs.
The present study explored the effects of coffee on the heart rate of patients who awaited clinical consultation in the OPDs of PHNB. Hence, the present study explored one primary research question; whether consumption of caffeinated beverages significantly increases heart rate in patients awaiting clinical consultation in an outpatient department of a hospital. The hospital authorities randomly collected data from 21 patients belonging to different age groups who awaited clinical consultation in the emergency department (ED) of PHNB. The respective individuals consumed caffeinated drinks at three different times of a day. The hospital authorities assessed the heart rate before and after the consumption of caffeinated drinks across concerned stakeholders. Hence, the present study was based on the experimental and quantitative analysis. The present report reflects an analysis of such data and the possible recommendations to the relevant authorities on the possibilities of replacing or withdrawing the provision of caffeinated drinks from the waiting room of the ED.
Part-2: Examination of Descriptive statistics
The heart rate of the respective study participants was collected through a standardized procedure. The primary data of the study participants are presented in Appendix-1. Descriptive statistics were conducted on the primary data. The details of the descriptive statistics are presented in Appendix-2. The distribution of study participants based on heart rate reflected that the study population was normally distributed. This is because the histogram analysis reflected a bell-shaped curve (fig 1.). Such data was complemented by the Anderson-Darling test for normality (A-squared 0.194) (Appendix-2). Hence, the sampling distribution based on heart rate was uniform. This is because the lower, middle and higher values of heart rate were uniformly distributed and the distribution was not tailed.

Fig 1: Histogram analysis reflected a bell-shaped curve
The coefficient of skewness and kurtosis was 0.033 and 0.078 respectively. Hence, the distribution bilaterally symmetrical and was not skewed towards any tail. The measures of central tendency and statistics of dispersion are reflected in Table 1.
Descriptive Statistics (Summary)
Heart rate (Before) Heart rate (After)
Mean 70.80952 82.14286
Median 70 80
Mode 70 95
standard deviation 9.74484 11.58139
variance 94.9619 134.1286
maximum 90 100
minimum 50 60
range 40 40
Table 1: measures of central tendency and statistics of dispersion
The measures of central tendency (the mean, median, and mode) and statistics of dispersion (variance and standard deviation) confirmed that the sampling distribution was bilaterally symmetrical (before the consumption of caffeinated drinks). This is because the mean, median, and mode almost lied on the same score (heart rate). However, the symmetry of the distribution was changed after the consumption of caffeinated drinks (because the mean, media, and mode differed in location). Moreover, the consumption of caffeinated drinks had an added variance component which pointed that consumption of caffeine could have statistically altered the heart rate in concerned stakeholders. The possibility of outliers was evaluated from the probability plot (Fig 2).

Fig 2: Possibility of outliers from the probability plot
Fig 2 reflected that there were very few outliers and the distribution had a fair goodness of fit in the scatter gram (R2 =0.979). The analysis of the probability plot reflected that certain errors could have been corrected to remove the outliers. One such measure would be to exclude extreme values both at the lower and higher tail of the distribution to minimize the chances of outliers being included in the sample. Such corrections would enhance the goodness of fit of the distribution and would thereby improve the reliability and validity of the findings.
Part 3: Examination of Inferential Statistics
The inferential, statistics that were undertaken include paired-t-tests, correlation analysis, and regression analysis. The inferential statistics were used to test the assumptions for the different research questions (main and sub-research questions). The present study explored one main research question and two sub-research questions. The sub-research questions were explored to address the main research question in a comprehensive manner. The research questions were analyzed based on appropriate hypotheses. The hypothesis testing for the respective research questions was based on the acceptance or rejection of the null hypothesis (Ho) or the alternative hypothesis respectively (Ha). The main research question that was explored in this study is “whether intake of caffeinated beverages significantly increases heart rate in patients who await clinical consultation in an outpatient department of a hospital?” The hypothesis for the main research question was as follows:
Ho = intake of caffeinated beverages does not significantly increase heart rate in patients who await clinical consultation in an outpatient department of a hospital (p>0.05).
Ha= intake of caffeinated beverages significantly increases heart rate in patients who await clinical consultation in an outpatient department of a hospital (p<0.05).
The first sub-research question that was explored in this study is “whether there is any significant correlation between heart rates before and after the consumption of caffeinated drinks?” The hypothesis for the first sub-research question was as follows
Ho= there is no significant correlation between heart rates before and after the consumption of caffeinated drinks (p>0.05).
Ha= there is a significant correlation between heart rates before and after the consumption of caffeinated drinks (p<0.05).
The second sub-research question that was explored in this study is “whether the heart rate of a patient after consumption of a caffeinated drink could be significantly predicted from their heart rate before consumption of caffeinated drinks?” The hypothesis for the second sub-research question was as follows:
Ho= the heart rate of a patient after consumption of a caffeinated drink cannot be significantly predicted from their heart rate before consumption of caffeinated drinks (p>0.05).
Ha= the heart rate of a patient after consumption of a caffeinated drink could be significantly predicted from their heart rate before consumption of caffeinated drinks (p>0.05).
t-Test: Paired Two Sample for Means 0.05        
   
  Before coffee after coffee diff 95% Confidence Interval  
Mean 70.80952 82.14 -11.333 -14.614 -8.053  
Variance 94.9619 134.1  
Observations 21 21  
Pearson Correlation 0.784862  
Hypothesized Mean Difference 0  
df 20  
t Stat -7.207  
P(T<=t) one-tail – Difference < Hypothesized Difference 0.000 1.000 Difference > Hypothesized Difference
T Critical one-tail 1.725  
P(T<=t) two-tail 0.000 Reject Null Hypothesis because p < 0.05 (Means are Different)
T Critical Two-tail 2.086          
Table 2: Comparison analysis (paired t-test)

Table 3: graphical representation of heart rate in study participants before and after the consumption of caffeinated drinks
Table 2 and Table 3 reflected that the consumption of coffee significantly increased heart rate across concerned stakeholders (p =0.000).
CORREL Before coffee after coffee
Before coffee 1.000 0.785
after coffee 0.785 1.000
p Values Before coffee after coffee
after coffee 0.000  
Table 4; Pearson’s Correlation Analysis
The Pearson’s correlation analysis reflected that heart rate before the consumption of coffee is significantly and positively correlated with the increase in heart rate after consumption of coffee across the study participants ( r- 0.785, p=0.000). Such findings implicate that if the heart rate of an individual before the consumption of coffee is more, then his or her heart rate would also increase after the consumption of coffee.
Regression analysis
SUMMARY OUTPUT Force Constant to Zero      
  FALSE  
Regression Statistics  
Multiple R 0.785  
R Square 0.616 Goodness of Fit < 0.80  
Adjusted R Square 0.596  
Standard Error 7.363  
Observations 21  
   
ANOVA  
  df SS MS F P-value  
Regression 1 1652.486507 1652.49 30.4802 0.000  
Residual 19 1030.084921 54.215  
Total 20 2682.571429        
  0.95
  Coefficients Standard Error t Stat P-value Lower 95% Upper 95%
Intercept 16.093 12.07100899 1.33321 0.198 -9.1718 41.3581
Before coffee 0.9328 0.168954595 5.52089 0.000 0.57915 1.28641
   
Heart Rate After coffee = 16.093 +0.933* Heart Rate Before coffee
Table 5: Regression analysis

Fig 3; Regression analysis
Likewise, the regression analysis not only confirmed the correlation analysis but also showed that the heart rate of concerned stakeholders after consumption of coffee could be significantly predicted from their heart rate before the consumption of coffee or caffeinated drinks.
Part 5: Conclusion and Recommendations
The descriptive statistics suggested that the data were normally distributed, while the inferential statistics reflected that caffeinated drinks increase heart rate in concerned stakeholders and such increase is dependent on their resting heart rate. However, the presence of underlying cardiovascular disorders across the study participants could have confounded the findings of the present study. Future studies should try to eliminate the confounding effects of blood pressure, age, and ethnicity to ensure improved reproducibility of the findings. Hence, the present report reflected that it would be wise for the management of PHNB to discourage the provision of caffeinated drinks in the ED.
References
Csiky B, & Simon G (1997). Effect of Neonatal Sympathectomy on the development of angiotensin II-induced hypertension. Am J Physiol., 272, 648–656
Geethavani, G, Rameswarudu, M & Reddy, R (2014) Effect of Caffeine on Heart Rate and Blood Pressure Journal of Scientific and Research Publications, 4(2), 1-2
Appendix-1
 Serial Number Before coffee after coffee
1 80 95
2 70 100
3 80 84
4 65 65
5 77 84
6 60 74
7 90 100
8 75 85
9 88 98
10 70 95
11 78 80
12 70 80
13 62 78
14 50 60
15 72 88
16 75 79
17 60 72
18 72 90
19 60 65
20 68 78
21 65 75
Appendix-2
Descriptive (Statistics Details)
Before Coffee After Coffee
Anderson-Darling Data is Normal Anderson-Darling Data is Normal
A-Squared 0.194 A-Squared 0.239
p 0.881 p 0.750
95% Critical Value 0.787 95% Critical Value 0.787
99% Critical Value 1.092 99% Critical Value 1.092
Mean 70.810 Mean 82.143
Mode 70, 60 Mode 95, 100, 84, 65, 80, 78
Standard Deviation 9.745 Standard Deviation 11.581
Variance 94.962 Variance 134.129
Skewedness 0.033 Skewedness -0.097
Kurtosis 0.078 Kurtosis -0.664
n 21.000 n 21.000
Std Err 2.126 Std Err 2.527
Minimum 50.000 Minimum 60.000
1st Quartile 65.000 1st Quartile 75.000
Median 70.000 Median 80.000
3rd Quartile 77.000 3rd Quartile 90.000
Maximum 90.000 Maximum 100.000
Range 40.000 Range 40.000
Confidence Interval 4.436 Confidence Interval 5.272
for Mean (Mu) 66.374 for Mean (Mu) 76.871
0.95 75.245 0.95 87.415
   
For Stdev (sigma) 7.455 For Stdev (sigma) 8.860
  14.072 16.724
   
for Median 65.000 for Median 75.000
  75.000 88.000
   
k-Factor Two-sided 40.391 k-Factor Two-sided 45.991
0.99 101.228 0.99 118.294
   
k-Factor One-sided 43.624 k-Factor One-sided 49.834
  97.995 114.451
   
k Two-sided 3.122 k Two-sided 3.122
k One-sided 2.790 k One-sided 2.790