A Virtual Reality-Based Cognitive Restorative Intervention Using Nature to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure.

The trial was a small pilot: 73 participants were randomized and 59 completed, so it cannot establish whether the intervention works. The protocol was changed because of the COVID-19 pandemic, and data were collected by telephone instead of the originally planned in-person measures. Heart failure severity was not directly measured at each follow-up visit, so changes in heart failure could have influenced outcomes. Baseline groups were not equivalent for body mass index and APOE4 status, with Nature-VR having higher body mass index, 37.4 versus 32.1, and lower APOE4 prevalence, 20.0% versus 44.1%. Both groups received weekly telephone calls, activity logs, and usual heart failure care, so improvements over time cannot be separated from those components. Some significant effects were in the opposite direction or changed after adjustment, including attention and executive function results, so they should not be read as treatment benefits.

Funding came from the American Heart Association Career Development Award, the Indiana University School of Nursing Research Refresh Fund, and a National Institute on Aging Paul B. Beeson Emerging Leaders Career Development Award. The authors declared no conflicts of interest.

Do not read the improvements in self-care and quality of life over 52 weeks as proof that Nature-VR works. Both groups had the same headset use, weekly calls, activity logs, and usual heart failure care, and there was no difference in change over time between groups for these outcomes.