The promise of the metaverse in cardiovascular health

Since Mark Zuckerberg announced he was rebranding Facebook Inc as Meta Platforms in order to develop a metaverse, there has been much debate about the promise of such a technological concept. The use of virtual reality (VR) has been analysed in evidence-based studies in niche areas, but the metaverse offers so much more: a complex, virtual realm where people can communicate with each other and build relationships. This is something worth considering in the delivery of healthcare. After Mark Zuckerberg announced his intention in October 2021 to focus huge resources on developing a network of three-dimensional virtual worlds focused on social media connection, known as a metaverse, investors, policy-makers, and the general public snapped to attention. The concept of the metaverse—defined as a VR space in which users can interact with other users in a computer-generated social environment—first appeared in science fiction novels such as Snow Crash and Ready Player One. This new ‘virtual internet’ has also presented such bright promises and high hopes that it naturally attracted the attention of visionaries and futurists too. Although many find it hard to wrap their heads around the concept, it still makes one wonder what the metaverse could possibly bring to medicine and healthcare. In recent years, studies have been published in peer-reviewed journals analysing how VR could improve patient care. It has been shown to ease pain, to aid mental health management and work against phobias and post-traumatic stress disorder. Normally, medical professionals see patients in person. It has been like this since the dawn of medicine but globalization, and the rising number of patients requiring medical help has led to the rise of remote consultations. The COVID-19 pandemic has skyrocketed the importance of telemedical platforms and services. Chatbots, video chat, and many more technologies have been used worldwide during the pandemic out of necessity, and many of these will stay with us in the so-called new normal after the pandemic. It follows that some doctor–patient meetings will continue to take place virtually. Being able to see the patient, their body and their reactions, virtually, have advantages over talking via a smartphone app or even remote video (Figure 1). Representation of a virtual reality doctor’s consultation. Second Life, an online multimedia platform where people create an avatar and socialize with others in an online virtual world, was launched in 2003 and is perhaps the closest thing to the metaverse concept so far. Although Second Life does not require a VR headset, it allows people in the form of their avatars, to come together in a virtual environment and engage in concerts, events, or get-togethers. Second Life has also hosted multiple medical and scientific conferences such as Sci Foo that brought together high-level scientists from around the world to discuss ideas outside the traditional event and conference setting. At these events, virtual delegates were able to display posters to allow others to interact with the content in a virtual yet interactive way. Whilst Second Life was strictly two-dimensional, the metaverse will allow people to join through VR, meaning that patients could virtually meet their physician to discuss their case or even analyse their data—much more realistic than an in-person visit or a telemedical app or video chat. A patient could meet their cardiologist as a digital avatar, have their consultation held in a virtual office, and even head to a virtual pharmacy to order their prescription medicine (or VR app). Following that, they can meet up with fellow patient communities to share, in their avatar form, their treatment progress and discuss new developments pertinent to their ailments. This offers an opportunity to enhance the user experience as compared to online patient forums or current telemedical visits which happen through a flat screen. As such visits have become commonplace, equipping them with a better interface could entice healthcare providers to extend their services to the metaverse. Moreover, with the interconnectedness that seems to be integral to this ‘new internet’, a patient’s digital avatar could carry their digital medical data collected from direct-to-consumer services and wearables—essentially any digital data—to share with their physician in the healthcare metaverse. Imagine patients sharing their cardiac status, fitness data, genetic risks for medication side effects, and cardiovascular diseases in three-dimension. Medical professionals could discuss more complicated cases and share peer support. I can imagine using VR for pre-operative planning where surgeons would be able to analyse the same structures based on echocardiography data in three-dimension. In interventional cardiology and cardiac surgery, skilled operators could be connected in a virtual world with fast 5G or soon even faster 6G. The metaverse could also spark a new era in medical events and medical education, which, let us be honest, would be a breath of fresh air for all of us. American VR in medicine expert Brennan M. Spiegel, MD, of Cedars Sinai Hospital in Los Angeles has already demonstrated the benefits of VR in medicine at live events when he was able to interact with the slides and speakers through a VR headset in front of a live audience (Figure 2). Representation of what a live cardiology meeting or congress could look like in virtual reality. Lecturers and professors could teach aspiring cardiologists the inner workings of the heart and the cardiovascular system in three-dimension with all of them looking at the same structures in the metaverse. However, as enticing as the prospect of extending healthcare to the metaverse sounds, we must consider its feasibility. From the practical reality of today, the metaverse looks like a strange dream and does not exist other than as a technological fantasy. If the technical obstacles remain hard to overcome, it is likely to remain a fantasy. VR equipment is expensive and ranges from hundreds of dollars to thousands. On top of that comes practical challenges with access to and the handling of VR headsets. Setting up a device can be a technical obstacle that is hard to overcome without external help or IT support. Having a heavy, 500 g load strapped to one’s forehead might also not be totally comfortable for extended periods of time. Moreover, the sheer volume of personal health data that will be involved represents a security and privacy concern. One technology that has been touted to address such concerns is Blockchain. Given how healthcare and electronic health systems have a notorious legacy of interoperability issues, thinking that the metaverse will take those woes away might be a pipe dream. Current metaverse contenders like Fortnite and Roblox are not interoperable, neither is Meta’s Horizon Worlds with Microsoft’s Mesh. One cannot bring content obtained, bought, or created in Roblox to Horizon Worlds and vice versa, and this goes against the concept of the metaverse in the first place. Whilst advanced technologies in digital health such as three-dimensional tissue bioprinting and artificial intelligence seem implausible, it is easy to conclude that the metaverse might be the furthest from the reality of healthcare today. It currently remains much easier to communicate with patients in person, through a phone or a social media channel than to envision something that seems like a far-fetched science fiction idea. Conflict of interest: None declared.