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

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.

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

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.

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.

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.