Virtual reality cognitive intervention for heart failure: CORE study protocol

Abstract

Introduction Heart failure (HF) is a prevalent, serious chronic illness that affects 6.5 million adults in the United States. Among patients with HF, the prevalence of attention impairment is reported to range from 15% to 27%. Although attention is fundamental to human activities including HF self‐care, cognitive interventions for patients with HF that target improvement in attention are scarce. The COgnitive intervention to Restore attention using nature Environment (CORE) study aims to test the preliminary efficacy of the newly developed Nature‐VR, a virtual reality‐based cognitive intervention that is based on the restorative effects of nature. Nature‐VR development was guided by Attention Restoration Theory. The target outcomes are attention, HF self‐care, and health‐related quality of life (HRQoL). Our exploratory aims examine the associations between attention and several putative/established HF biomarkers (eg, oxygen saturation, brain‐derived neurotrophic factor, apolipoprotein E, dopamine receptor, and dopamine transporter genes) as well as the effect of Nature‐VR on cognitive performance in other domains (ie, global cognition, memory, visuospatial, executive function, and language), cardiac and neurological events, and mortality. Methods This single‐blinded, two‐group randomized‐controlled pilot study will enroll 74 participants with HF. The Nature‐VR intervention group will view three‐dimensional nature pictures using a virtual reality headset for 10 minutes per day, 5 days per week for 4 weeks (a total of 200 minutes). The active comparison group, Urban‐VR, will view three‐dimensional urban pictures using a virtual reality headset to match the Nature‐VR intervention in intervention dose and delivery mode, but not in content. After baseline interviews, four follow‐up interviews will be conducted to assess sustained effects of Nature‐VR at 4, 8, 26, and 52 weeks. Discussion The importance and novelty of this study consists of using a first‐of‐its kind, immersive virtual reality technology to target attention and in investigating the health outcomes of the Nature‐VR cognitive intervention among patients with HF.

Association of Heart Failure With Cognitive Decline and Development of Mild Cognitive Impairment and Dementia

“…In this study, the estimated 5-year incidence of developing dementia was 26.8% among participants with HF who had normal cognition at baseline, which is significantly higher than the 17.2% among those without HF. Thus, interventions are needed for patients with HF to improve their cognitive function and slow cognitive decline with a better understanding of types (eg, physical exercise, cognitive training, cognitive restoration, or multicomponent interventions) [23][24][25][26][27][28] and timing (eg, upon clinical diagnosis of HF, hospital admissions) of intervention.…”

Computerized Cognitive Training and 24-Month Mortality in Heart Failure

“…54 Computerized cognitive training may need to be delivered over a longer period or in combination with other interventions to improve cognitive function and reduce mortality in HF. For example, testing CCT in combination with a virtual reality natural restorative environment intervention 55 or a physical activity intervention 56 may be synergistic and improve outcomes. Although these are plausible reasons for lack of nonsignificant findings, it may be that the findings are true and CCT does not predict 24-month all-cause mortality.…”

Nature-based virtual reality intervention to manage stress in family caregivers of allogeneic hematopoietic stem cell transplant recipients: a two-phase pilot study protocol

“…Therefore, considering that caregiving stress is a type of chronic stress, we intend to set the intervention duration longer. The 4-week intervention duration was chosen based on two recent ongoing trials testing the effects of VR nature or relaxation for four weeks ( 31 , 32 ).…”