The Effects of Virtual Reality on Anxiety, Pain, and Physiological Parameters During Invasive Coronary Angiography: A Systematic Review and Meta-Analysis

Abstract

Invasive coronary angiography (ICA) can provoke considerable anxiety, pain, and physiological stress, which may affect patient outcomes. Virtual reality (VR) is a nonpharmacological intervention that may help alleviate these adverse responses. This study evaluated the effects of VR on anxiety, pain, and physiological parameters in adults undergoing ICA. We searched PubMed, Cochrane, Web of Science, Scopus, Embase, and Google Scholar from inception to April 21, 2025, for randomized controlled trials (RCTs) comparing VR to standard care or no intervention in adult ICA patients. Eligible studies reported at least one of the following outcomes: anxiety, pain, systolic /diastolic blood pressure, heart rate, or respiratory rate. Random-effects meta-analyses were conducted, and results were presented as standardized or mean differences (MDs) with 95% confidence intervals (CIs). Seven RCTs involving 729 participants were included. VR significantly reduced anxiety symptoms (standardized mean difference = −1.12, 95% CI: −1.71 to −0.52, P < 0.01; I² = 88.95%), systolic blood pressure (MD = −9.69 mm Hg, 95% CI: −15.60 to −3.78, P < 0.01), heart rate (MD = −5.09 bpm, 95% CI: −6.39 to −3.80, P < 0.01), respiratory rate (MD = −1.12 breaths/min, 95% CI: −2.21 to −0.03, P = 0.04), and postoperative pain (MD = −2.02, 95% CI: −3.90 to −0.13, P = 0.04). Diastolic blood pressure showed a nonsignificant trend (MD = −5.31 mm Hg, 95% CI: −11.06 to 0.45, P = 0.07). VR is a promising adjunct to standard care, offering reductions in anxiety symptoms, pain, and physiological stress markers during ICA. Further high-quality RCTs are warranted to validate these findings.