The effectiveness of virtual reality on cardiac procedure related anxiety: a systematic review and meta-analysis

Abstract

Abstract Introduction Cardiac procedures are associated with anxiety which can lead to worse outcomes1 2. However, virtual reality (VR) may offer an innovative approach of a more informative experience enhancing procedural understanding and reducing procedure-related anxiety. Previous studies have shown benefits of VR related therapies in improving anxiety related to cardiac rehabilitation and different surgical procedures3 4. Purpose To evaluate the effectiveness of VR in improving cardiac procedure related anxiety compared to standard of care in patients undergoing any type of cardiac procedure. PROSPERO ID CRD 42023395395 Methods A comprehensive search strategy was used to search the online databases (MEDLINE, EMBASE, CINAHL, Web of Sciences, and COCHRANE) for randomized controlled trials (RCTs) on VR, cardiac procedures, and anxiety. Risk of bias was analyzed using revised Cochrane risk of bias tool for RCTs5. Effect estimate was reported as standardized mean difference (SMD) with a 95% confidence interval. Random effect model was used to generate effect estimate if heterogeneity was significant (I2>60%), otherwise fixed effect model was used. Sensitivity analysis was performed based on the type of anxiety questionnaire used and p-value of <0.05 was taken as statistically significant. Statistical analysis was conducted using Stata SE version 17.0 (College Station, TX, USA) and RevMan5. Results A total of 171 study participants were part of four studies included in the meta-analysis. Three studies were part of narrative synthesis. Mean age was between 44±11 years and 83±6.4 years. VR group did not show significant improvement in anxiety compared to standard of care (SMD 0.11, 95% CI -0.90, 1.11). However, significant improvement in anxiety was seen in VR group on sensitivity analysis after including studies that utilized validated anxiety assessment State-Trait Anxiety Inventory (STAI) questionnaire6 only ( (SMD -0.39, 95% CI -0.74, -0.05). Egger’s regression test did not identify any significant publication bias (p=0.64). Conclusion Our findings suggest that VR significantly improves anxiety related to cardiac procedures when assessed using validated anxiety questionnaire. Two out of three studies included in the narrative synthesis also showed improvement in anxiety levels, despite using non-standardized questionnaires. However, further studies are needed to investigate the effectiveness of novel VR technology in reducing cardiac procedure-related anxiety while comparing the use of standardized and non-standardized anxiety assessment tools.Forest Plot for Anxiety OutcomeSensitivity take-one-out analysis.