Clinical application of VR in patients with cardiovascular disease: state of the art

Despite the declining incidence and mortality rates of atherosclerotic cardiovascular disease (ASCVD) in numerous European nations, this disease remains a major cause of morbidity and mortality (1). Patients with ASCVD suffer from a plurality of physical and psychological symptoms that can significantly affect daily life activities (2). A notable psychological sequelae in this cohort is the apprehension regarding disease recurrence, which has been correlated with manifestations of posttraumatic stress disorder, prognostic deterioration, diminished wellbeing, and reduced quality of life (3). Additional psychological burdens include concerns about long-term survival, distress related to the initial diagnosis, trepidation about potential cardiac events, and uncertainty regarding clinical outcomes, all of which may precipitate symptoms of anxiety and depression (3). Moreover, hospitalization itself can be a source of psychological distress, often exacerbating recovery uncertainties and engendering feelings of helplessness. Anxiety is one of the most frequently observed psychological reactions among patients awaiting various surgeries and can occur in up to 80% of patients (4). An increased level of preoperative anxiety is related to both psychological and somatic negative consequences, which subsequently affects anesthesia administration, postoperative care, treatment, and the recovery process (4). Preoperative anxiety is also considered a risk factor for mortality in patients after surgery (4). Furthermore, the duration of procedures can increase acute psychological symptoms (5). For these reasons, improving psychological symptoms in patients with ASCVD is a crucial goal.

Virtual reality (VR) is an innovative technology that has been shown to improve outcomes related to ASCVD. VR is defined as the use of interactive simulations generated with computer hardware and software that allow patients to be physically and psychologically present in virtual environments and perceive real feelings, emotions, perceptions, and interactions (6). In this review, we describe the state-of-the-art effectiveness of VR applied to ASCVD patients in different settings.