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. 2025 Aug;4(8):101976.
doi: 10.1016/j.jacadv.2025.101976. Epub 2025 Jul 18.

Virtual Reality to Reduce Preprocedural Anxiety During Invasive Coronary Angiography: The VR InCard Trial

Tjitske D Groenveld  1 , Esther H W Breunissen  2 , Judith L Bonnes  2 , Linda Garms  1 , Naomi Scholten  1 , Aysun Cetinyurek-Yavuz  2 , Lokien X van Nunen  2 , Marleen X van Wely  2 , Cyril Camaro  2 , Tim J F Ten Cate  2 , Aukelien C Dimitriu-Leen  2 , Niels van Royen  2 , Robert Jan M van Geuns  2 , Dominique V M Verhaert  3 , Harry van Goor  1 , Peter Damman  4
Affiliations

Virtual Reality to Reduce Preprocedural Anxiety During Invasive Coronary Angiography: The VR InCard Trial

Tjitske D Groenveld et al. JACC Adv. 2025 Aug.

Abstract

Background: Anxiety affects one-third of patients undergoing invasive coronary angiography (ICA). Benzodiazepines are commonly administered but have modest efficacy. Virtual reality (VR) therapy is promising in reducing anxiety around various procedures.

Objectives: This study aimed to evaluate the effect of VR on preprocedural anxiety in patients undergoing ICA.

Methods: This randomized controlled trial included adults undergoing ICA for chronic coronary syndrome, coronary vasomotor function testing, or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with a numeric rating scale (NRS) anxiety score of 4 or more. The control group received usual care with benzodiazepines if needed. The intervention group additionally received 2 VR therapysessions of approximately 20 and 10 minutes before ICA. The primary outcome was preprocedural NRS anxiety. Secondary outcomes included NRS anxiety at other timepoints, physiological stress parameters, and patient- and provider-reported outcome measures. Subgroup analyses were conducted by sex and ICA indication.

Results: A total of 99 patients were included, 47 in the intervention group and 52 in the control group. No difference was observed in preprocedural anxiety. After adjusting for baseline anxiety, the intervention group showed a significant reduction in preprocedural NRS anxiety (mean difference: 0.9; 95% CI: 0.2-1.6; P = 0.010). No significant differences were observed in secondary outcomes. Patients undergoing ICA for NSTE-ACS experienced the greatest effect.

Conclusions: VR therapy did not reduce preprocedural anxiety in patients undergoing ICA. After adjusting for baseline anxiety, VR therapy significantly reduced preprocedural anxiety, with the most pronounced effect in patients undergoing ICA for NSTE-ACS. VR therapy presents a viable nonpharmacological complement to traditional treatments for procedure-related anxiety.

Keywords: anxiety; coronary angiography; nonpharmacological therapy; periprocedural anxiety; virtual reality.

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Conflict of interest statement

Funding support and author disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Flowchart NRS = numeric rating scale; VR = virtual reality.
Figure 2
Figure 2
Mean and SD for Numeric Rating Scale Anxiety ITT and PP analysis with and without adjusting for baseline anxiety and benzodiazepine use; ∗P < 0.05. ITT = intention to treat; NRS = numeric rating scale; PP = per protocol.
Figure 3
Figure 3
Mean and SD for Numeric Rating Scale Anxiety Over Time Intention-to-treat analysis; ∗P < 0.01. Abbreviations as in Figure 1.
Central Illustration
Central Illustration
Virtual Reality Therapy Leads to Reduced Anxiety in Patients Undergoing Invasive Coronary Angiography ∗P < 0.05. CAG = coronary angiography; CFT = coronary function test; NSTE-ACS = non-ST-segment elevation-acute coronary syndrome; RMSSD = root mean of successive difference; other abbreviations as in Figures 1 and 2.
See this image and copyright information in PMC

References

    1. Delewi R., Vlastra W., Rohling W.J., et al. Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. Int J Cardiol. 2017;228:926–930. - PubMed
    1. Gallagher R., Trotter R., Donoghue J. Preprocedural concerns and anxiety assessment in patients undergoing coronary angiography and percutaneous coronary interventions. Eur J Cardiovasc Nurs. 2010;9(1):38–44. - PubMed
    1. Munk P.S., Isaksen K., Brønnick K., Kurz M.W., Butt N., Larsen A.I. Symptoms of anxiety and depression after percutaneous coronary intervention are associated with decreased heart rate variability, impaired endothelial function and increased inflammation. Int J Cardiol. 2012;158(1):173–176. - PubMed
    1. Wang Y., Anesi J., Maier M.C., et al. Sympathetic nervous system and atherosclerosis. Int J Mol Sci. 2023;24(17) - PMC - PubMed
    1. Christoph M., Christoph A., Dannemann S., et al. Mental symptoms in patients with cardiac symptoms and normal coronary arteries. Open Heart. 2014;1(1) - PMC - PubMed

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