Novel Virtual Reality Application for Stress Reduction Among Patients with or At Risk for Cardiovascular Disease (Preprint)

BACKGROUND Virtual Reality (VR) has emerged as a promising, low-risk strategy to manage many forms of psychological stress and may be a modality to improve cardiovascular health. Recent scientific statements on the mind-heart-body connection call for better adherence to psychological screening and adoption of more holistic, “behavioral cardiology” interventions that improve overall health of patients with or at risk for cardiovascular disease (CVD). OBJECTIVE The aim of this study is to explore how a VR experience can aid in stress reduction among patients with/at risk for CVD. METHODS A convergent mixed-methods approach was used for this single-arm prospective pilot study. 20 patients were recruited from UCLA adult cardiology clinics & cardiac rehabilitation. Surveys and physiologic parameters were collected before, during, and after a 30-minute VR experience aimed at relaxation. The primary outcome was the State-Trait Anxiety Inventory-State scale (STAI-S). They participated in a 90-minute visit during which they completed surveys, including the STAI-S, before & after a 30-minute VR experience. Physiological parameters were also collected before, during, and after the experience. Visits concluded with semi-structured interviews analyzed with inductive thematic analysis to add depth and nuance to our analysis. RESULTS STAI-S scores after the VR experience were significantly decreased from baseline (P<0.001). Verbal feedback revealed that participants experienced a relaxing sense of “distance from stress” moderated by unexpected, intense audiovisual components. Heart rate significantly decreased (P<0.001) while blood pressure (systolic: P=0.75, diastolic: P=0.60) & galvanic skin response (P=0.5) remained the same. Changes in heart rate variability parameters were consistent with increased vagal tone over time but were only statistically significant at certain timepoints. Survey results and interviews generally indicated safety, tolerability, and openness to using VR again. CONCLUSIONS This sample of patients with cardiovascular disease or risk of cardiovascular disease had above-average stress, supporting epidemiological data and the need for increased awareness of the mind-heart-body connection; the statistically and clinically significant decrease in subjective perception of stress partially converged with physiologic data. Overall, the VR intervention was a safe, viable stress reduction method. This study can help inform future research utilizing this immersive therapeutic (or others) to reduce cardiovascular risk profiles. CLINICALTRIAL UCLA Institutional Review Board (#21-000705) and the ClinicalTrials.gov registry number was NCT04984655 https://clinicaltrials.gov/study/NCT04984655