Abstract 13139: Preliminary Efficacy of a Cognitive Restorative Nature Intervention to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure

Abstract

Background: Cognitive dysfunction is prevalent among patients with heart failure (HF) and decreases self-care behaviors and health-related quality of life (HRQL). Goal: The purpose was to test preliminary efficacy of a newly developed virtual reality-based cognitive restorative nature intervention (Nature-VR based on Attention Restoration Theory) on improving attention, HF self-care, and HRQL. Methods: In this 2-group randomized controlled trial, 73 patients with Stage C HF were enrolled. The Nature-VR intervention group (n=37) viewed 3-dimensional nature pictures delivered by a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks. The attention control group (n=36) viewed 3-dimensional urban pictures (Urban-VR) delivered by a virtual reality headset at the same frequency of Nature-VR. Outcomes were: attention measured by Oral Trail Making A and Digit Span Forward; HF self-care measured by Self-care of Heart Failure Index; and HRQL measured by Minnesota Living with Heart Failure Questionnaire. Outcomes were assessed at baseline, 4, 8, 26, and 52 weeks by telephone interviews due to COVID-19 pandemic. Linear mixed models with intention-to-treat analysis were used to test effects of group, time, and group-by-time interactions. Results: Of 73 patients, 41 were women. Self-reported race was 1 Asian, 12 African American, and 60 White. Mean age was 66 years. NYHA class was I/II=33, III=30, and 10 were missing. Sixty-eight patients (93%) completed the interventions; 56 (79% of 68) had ≥ 80% adherence; 51 (70%) completed the study. In mixed models, no significant group-by-time interactions were found in attention, HF self-care, and HRQL. HF self-care (maintenance, management, symptom perception, and confidence) significantly improved over time (p < .001) in both groups. There was significant improvement on symptom perception (p= .004, better in Nature-VR). HRQL showed significant group (p = .041, worse in Nature-VR) and time effects (p = .047, both groups improved). Conclusions: Although preliminary efficacy of Nature-VR compared with Urban-VR was not supported, HF self-care and HRQL improved over 52 weeks. Future testing is indicated of multimodal interventions that include Nature-VR to improve improving self-care and HRQL.