{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T13:32:30Z","timestamp":1793799150518,"version":"4.6.1"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,3,24]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Patients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are commonly used to reduce periprocedural anxiety, although the effect is modest. Virtual reality (VR) is a promising non-pharmacological intervention to reduce anxiety in patients undergoing ICA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>A single-centre open-label randomised controlled trial is conducted assessing the effectiveness of add-on VR therapy on anxiety in 100 patients undergoing ICA and experiencing anxiety in a periprocedural setting. The primary outcome is the Numeric Rating Scale (NRS) anxiety score measured just before obtaining arterial access. Secondary outcomes include postarterial puncture and postprocedural anxiety, patient-reported outcome measures (PROMs) of anxiety and physiological measurements associated with anxiety. The NRS anxiety level and physiological measurements are assessed five times during the procedure. The PROM State-Trait Anxiety Inventory and Perceived Stress Scale are completed preprocedure, and the PROM STAI and the Igroup Presence Questionnaire are performed postprocedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The protocol of this study has been approved by the Research Ethics Committee of the Radboud University Medical Centre, the Netherlands (CMO Arnhem-Nijmegen, 2023\u201316586). Informed consent is obtained from all patients. The trial is conducted according to the principles of the Helsinki Declaration and in accordance with Dutch guidelines, regulations, and acts (Medical Research involving Human Subjects Act, WMO).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Registration details<\/jats:title>\n                  <jats:p>Trial registration number: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06215456\">NCT06215456<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2024-002628","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T23:30:25Z","timestamp":1712100625000},"page":"e002628","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct06215456","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06215456","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1535-274X","authenticated-orcid":false,"given":"Esther Helena Wouda","family":"Breunissen","sequence":"first","affiliation":[{"name":"Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjitske Diederike","family":"Groenveld","sequence":"additional","affiliation":[{"name":"Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Garms","sequence":"additional","affiliation":[{"name":"Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith L","family":"Bonnes","sequence":"additional","affiliation":[{"name":"Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"van Goor","sequence":"additional","affiliation":[{"name":"Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Damman","sequence":"additional","affiliation":[{"name":"Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"key":"2025081612032574000_11.1.e002628.1","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.ijcard.2016.11.043","article-title":"Anxiety levels of patients undergoing coronary procedures in the Catheterization laboratory","volume":"228","author":"Delewi","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025081612032574000_11.1.e002628.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcnurse.2009.09.001"},{"key":"2025081612032574000_11.1.e002628.3","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/S0924-9338(11)72112-5","article-title":"Anxiety in patients before coronary angiography","volume":"26","author":"Tel","year":"2011","journal-title":"Eur Psychiatr"},{"key":"2025081612032574000_11.1.e002628.4","doi-asserted-by":"crossref","DOI":"10.1136\/heartjnl-2013-303992.203","article-title":"Preoperative anxiety is associated with higher blood pressure in patients waiting for surgery","volume":"99","author":"Chunhui","year":"2013","journal-title":"Heart"},{"key":"2025081612032574000_11.1.e002628.5","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2018-000833","article-title":"Premedication to reduce anxiety in patients undergoing coronary angiography and percutaneous coronary intervention","volume":"5","author":"Vlastra","year":"2018","journal-title":"Open Heart"},{"key":"2025081612032574000_11.1.e002628.6","doi-asserted-by":"crossref","unstructured":"Wang R , Huang X , Wang Y , et al . 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