Feasibility of a Novel Virtual Reality-based Cognitive Intervention to Improve Attention in People with Heart Failure

Abstract

Introduction Patients with heart failure (HF) often experience cognitive dysfunction and attention is one of the most commonly impaired cognitive domains. Attention is critical to initiate, maintain, and complete self-care activities effectively. In our previous work, we were able to show some improvements in attention in HF patients with a computer-based natural restorative environment intervention (NRE-C) based on Attention Restoration Theory. Building on that past work, we developed a novel, virtual reality-based, prototype intervention to improve attention by increasing interactions with nature. Aims The aim was to test feasibility (completion, safety, satisfaction, attention improvement) of the virtual reality-based natural restorative environment intervention (NRE-VR) with enhanced immersiveness. Methods Ten patients with HF (stage C; NYHA Class II/III) were sequentially assigned to the novel NRE-VR (n=5) and then to NRE-C (n=5). NRE-VR included 10 pictures of 360 degree nature views using Gear VR (1 minute/picture, total of 10 minutes), and NRE-C included 50 pictures of 2-dimensional nature views using a laptop computer screen (7 seconds/picture, approximately 7 minutes in total). Attention was examined using Multi-Source Interference Task, Digit Span, Trail Making, and Stroop tests immediately before and after the intervention. Adequacy of HF self-care was examined by the Self-Care of Heart Failure Index at pre-test. Results The sample was 50% female, with a mean age of 59 years, mean of 14 years of education, and mean LVEF of 44%. HF self-care was poor on average (maintenance=63.66 ± 15.67, management=60.00 ± 23.69, confidence=61.16 ± 15.28). Improved performances on the neuropsychological tests of attention were consistently found after NRE-VR except for Digit Span Forward. Compared with NRE-C, NRE-VR group had greater improvements on Multi-Source Interference Task and Trail Making Test ( Table 1 ). All 10 patients completed the study without adverse event. Satisfaction with the intervention was slightly higher among NRE-VR than NRE-C as was enjoyment and immersion. Patients in NRE-C were provided an opportunity to try NRE-VR at the end of the interview and 4 patients tried. All 4 patients preferred having NRE-VR than NRE-C. Conclusions The prototype of NRE-VR was feasible, safe, and demonstrated potential to improve attention among people living with HF.