Table 3.

General characteristics of included studies.

Author, year	Country	Journal	Target group	Type of VR application	Intervention group/control group	Sample size	Detail of groups (sex, age)	Session detail	Measured outcome	Outcome
Jozwik et al., 2022 [24]	Poland	Healthcare	Patients with CHD	Psychological rehabilitation	CR + VR vs CR + schultz autogenic training	N = 34 VR+ CR = 11 CG = 23	Sex: 34 M Age CG: 62.52 ± 7.18 EG: 66.55 ± 9.63	2 times a week for 4 weeks	(i) Anxiety level (ii) Depression level (iii) Emotional tension level (iv) External stress level (v) Intrapsychic stress level (vi) Risk of lying	This study verified that VR leads to an improvement in the mental state of the patients
Szczepanska-Gierachaet al., 2021 [25]	Poland	Cyberpsychology, behavior, and social networking	Patients with CAD	Psychological rehabilitation	CR + VR vs CR + schultz autogenic training	N = 32 VR+ CR = 15 CG = 17	Sex EG: 9 F, 6 M CG: 11 F, 6 M Age CG: 68.41 ± 5.06 EG: 69.47 ± 7.54	2 times a week for 4 weeks	(i) Anxiety level (ii) Depression level (iii) Emotional tension level (iv) External stress level (v) Intrapsychic stress level (vi) Risk of lying	This study confirmed that VR leads to an improvement in the mental state of the patients
Ribeiro et al., 2021 [26]	Brazil	Physiotherapy research international	Patients undergoing CABG	Physical rehabilitation	VR vs control group and EMG	N = 48 VR = 17 EMG = 15 CG = 16	Sex CG: 4 F, 11 M EMG: 2 F, 13 M VR: 7 F, 10 M Age CG: 60.3 ± 8.3 EMG: 58.3 ± 7.7 VR: 62.1 ± 9.0	Not clear	(i) Heart rate variability (ii) Time of discharge of hospital	Physiotherapy protocols, combined with VR training, improved a higher number of indicator indices and a shorter hospital stay after surgery
Patel et al., 2021 [27]	USA	The international journal of cardiovascular imaging	Medical students, residents, fellows, nurses, advanced practitioners, junior attending physicians, dieticians, and bioengineering PhD students	Anatomy education	VR vs a desktop computer interface	N = 51 VR = 24 CG = 27	Sex CG: 18 F, 9 M VR: 16 F, 8 M Age CG: 30 VR: 28	Not mentioned	(i) Visuospatial knowledge	There was no statistically significant difference between VR and the control group
Laghlam et al., 2021 [28]	France	Annals of intensive care	Patients undergoing cardiac surgery	Psychological rehabilitation	VR vs kalinox	N = 180 VR: 90 CG90	Sex CG: 18 F, 72 M VR: 28 F, 62 M Age CG: 68 VR: 68	5 min before the removal of the drains, and was continued for 10 min after	(i) Pain level (ii) Anxiety level	Although VR was well tolerated by patients and allowed a satisfying self-reported anxiety control, it failed to confirm noninferiority compared to Kalinox® for controlling pain and anxiety
Keshvari et al., 2021 [16]	Iran	Egyptian heart journal	Patients undergoing coronary angiography	Physical rehabilitation/psychological rehabilitation	VR vs usual care	N = 80 VR = 40 CG = 40	Sex CG: 15 F, 25 M VR: 8 F, 32 M Age CG: 52.08 ± 4.002 VR: 50.95 ± 4.120	5 min for each patient	(i) Anxiety level (ii) Heart rate (iii) Respiratory rate (iv) Blood pressure	VR distraction was effective in reducing anxiety before coronary artery angiography
Jozwik et al., 2021 [29]	Poland	Journal of clinical medicine	Patients with CAD	Psychological rehabilitation	CR + VR vs CR + schultz autogenic training	N = 77 VR = 28 CG = 49	Sex CG: 25 F, 24 M VR: 17 F, 11 M Age CG: 63.96 ± 6.89 VR: 66.00 ± 9.73	8 sessions, 3 times a week	(i) Anxiety level (ii) Depression level (iii) General stress level (iv) Emotional tension level (v) External stress level (vi) Intrapsychic stress level	The virtual environment with standard CR leads to a significant improvement in patients' mental health
Jozwik et al., 2021 [30]	Poland	Medicina	Patients with IHD	Psychological rehabilitation	CR + VR vs CR + schultz autogenic training	N = 43 VR+ CR = 17 CG = 26	Sex CG: 26 F VR: 17 F Age CG: 65.23 ± 6.49 VR: 65.65 ± 10.07	3 times a week for 8 weeks	(i) Generalized stress level (ii) Emotional tension level (iii) External stress level (iv) Intrapsychic stress level (v) Depression level (vi) Anxiety level	VR therapy is an efficient and interesting supplement to cardiac rehabilitation, with proven efficacy in reducing stress levels
Gulick et al., 2021 [31]	USA	Journal of medical internet research	Patients undergoing cardiac rehabilitation	Physical rehabilitation/psychological rehabilitation	VR vs standard care	N = 35 VR = 16 CG = 19	Age: 61 ± 9.9	Not clear	(i) Knowledge retention (ii) Patient satisfaction (iii) Engagement	No improvements were seen in the VR group
da Cruz et al., 2021 [32]	Brazil	Physical therapy & rehabilitation journal	Patients with cardiovascular diseases or risk factors	Psychological rehabilitation	CR + VR vs traditional CR	N = 61 VR+ CR = 30 CG = 31	Sex CG: 7 F, 24 M VR: 15 F, 15 M Age CG: 66.83 ± 10.93 VR: 63.27 ± 12.68	3 times a week for 12 weeks	(i) Adherence (ii) Motivation (iii) Engagement	Although VR increased program adherence but decreased patient motivation and absorption
Chang et al., 2021 [33]	Taiwan	Journal of the Chinese medical association	AF patients preparing for ablation	AF preprocedural education	VR vs paper-based materials	N = 33 VR = 11 CG = 22	Sex CG: 8 F, 14 M VR: 9 F, 2 M Age CG: 30–40 (2), 40–50 (4), 50–60 (4), and >60 yrs (12) VR: 30–40 (0), 40–50 (1), 50–60 (4), and >60 yrs (6)	Not clear	(i) Self-efficacy (ii) Satisfaction	VR decreased periprocedural anxiety and smoothed the procedure of AF catheter ablation
Zinchenko et al., 2020 [34]	Russia	New ideas in psychology	Humanitarian students	Anatomy education	VR vs paper and 3D interactive model on a computer display	N = 45	Sex CG1: 9 M CG2: 8 M VR: 9 M Age CG1: 21.2 ± 2.3 CG2: 22.9 ± 3.5 VR: 22.7 ± 3.6	15 min	(i) Number of correct answers	VR was more efficient than reading texts or interacting with a 3D model on a computer screen
Katz et al., 2020 [35]	USA	Journal of medical internet research	Anesthesiology residents	ACLS training	VR vs high-fidelity simulation	N = 23 VR = 11 CG = 12	Sex: 17 M, 8 F Age: 25–35	Not clear	(i) Technical skills (ii) Behavioral skills (iii) Cost	Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction
Hessabi, 2020 [36]	Iran	International journal of pharmaceutical and phytopharmacological research	Patients admitted to the CCUs	Psychological rehabilitation	VR vs usual care	N = 60 VR = 30 CG = 30	Sex CG: 15 M, 15 F VR: 15 M, 15 F Age CG: 49.92 ± 7 VR: 52.03 ± 6	On the second and third night of admission for 15 min	(i) Anxiety level	VR can effectively reduce anxiety in hospitalized patients in the CCU
García-Bravo et al., 2020 [37]	Spain	International journal of environmental research and public health	Patients with IHD	Physical rehabilitation/psychological rehabilitation	CR + VR vs traditional CR	N = 20 VR = 10 CG = 10	Age CG: 53.7 ± 10.30 EG: 48.70 ± 6.66	2 times a week for 8 weeks (60 min)	(i) Ergometry (ii) Metabolic equivalents (iii) Functional independence measure (iv) 6MWT (v) Aerobic capacity and endurance (vi) Quality of life (vii) Depression level (viii) Satisfaction (ix) Adherence	VR could be incorporated into CR programs
Alves da Cruz et al., 2020 [38]	Brazil	Archives of physical medicine and rehabilitation	Patients with cardiovascular diseases or risk factors	Physical rehabilitation	VR vs regular CR	N = 27	Sex: 14 M, 13 F Age: 63.40 ± 12.71	Each VRBT or CR session lasted 85 minutes	(i) Heart rate (ii) Blood pressure (iii) Respiratory rate (iv) Rating of perceived exertion (v) peripheral oxygen saturation (vi) Heart rate reserve (vii) How long the patient maintained the prescribed (viii) HRR	VR produces similar physiological acute hemodynamic effects in CR
Maresky et al., 2019 [39]	Canada	Clinical anatomy	Medical students	Anatomy education	VR vs independent study	N = 42 VR = 28 CG = 14	Age: 18–34	30 min	(i) Number of correct answers	This study demonstrates the viability and the effectiveness of VR in teaching cardiac anatomy
Vieira et al., 2018 [40]	Portugal	Disability and rehabilitation: assistive technology	Patients with CAD	Physical rehabilitation/psychological rehabilitation	VR vs usual care and paper booklet	N = 33 VR = 11 EG2 = 11 CG = 11	Sex: 33 M Age EG1: 55 ± 9.0 EG2: 59 ± 11.3 CG: 59 ± 5.8	3 times a week for 6 months	(i) Executive function (ii) Ability to switch information (iii) Working memory (iv) Selective attention (v) Conflict resolution ability (vi) Quality of life (vii) Depression level (viii) Anxiety level (ix) Stress level	The VR improved attention and conflict resolution ability, revealing the potential of CR, specifically with virtual reality exercise, on executive function
Vieira, 2017 [41]	Portugal	European journal of integrative medicine	Patients with CAD	Physical rehabilitation	VR vs usual care and paper booklet	N = 33 EG2 = 11 CG = 11	Sex: 33 M Age EG1: 55 ± 9.0 EG2: 59 ± 11.3 CG: 59 ± 5.8	3 times a week for 6 months	(i) Total cholesterol levels (ii) High-density lipoprotein (iii) Low-density lipoprotein (iv) Triglycerides (v) Lean mass (vi) Body mass index (vii) Body fat at the trunk (viii) Total body fat (ix) Waist-to-height ratio	VR had a positive effect on body composition
Voelker et al., 2016 [42]	Germany	Journal of interventional cardiology	Cardiology fellows	Cardiac catheterization training	VR vs lectures	N = 18 VR = 9 CG = 9	Not mentioned	7.5 hours	(i) Participant's performance quality (ii) Procedure time (iii) Fluoroscopy time	VR simulation training improved the performance level of cardiology fellows
Valdis et al., 2015 [43]	Canada	Innovations-technology and techniques in cardiothoracic and vascular surgery	Surgical trainees	Robotic cardiac surgery training	VR vs no training	N = 19 VR = 9 CG = 10	Sex CG: 6 M, 4 F VR: 8 M, 2 F Age CG: 29.9 ± 2.4 VR: 32.7 ± 6.1	The average duration of VR: 9.3 hours	(i) Standardized robotic internal thoracic artery harvest (ii) Mitral valve annuloplasty	VR can significantly improve the efficiency and quality of learning in robotic cardiac surgery
Khanal et al., 2014 [44]	USA	Journal of biomedical informatics	Care providers	ACLS training	VR vs traditional ACLS training	N = 148	Sex: 10 M, 138 F	30 minutes	(i) Time for each task	VR-based ACLS training can provide a learning experience similar to face-to-face training
Cacau et al., 2013 [45]	Brazil	Revista brasileira de cirurgia cardiovascular	Patients in the postoperative period	Physical rehabilitation/psychological rehabilitation	VR vs conventional physical therapy	N = 60 VR = 30 CG = 30	Sex CG: 16 M, 14 F VR: 13 M, 17 F Age CG: 52 ± 2.4 VR: 49.2 ± 2.6	Twice a day	(i) Functional performance (ii) 6MWT (iii) Length of hospitalization (iv) Functional independence measure (v) Quality of life	Adjunctive treatment with VR demonstrated better functional performance in patients
Bagai et al., 2012 [46]	Canada	Circulation-cardiovascular interventions	Cardiology trainees	Cardiac catheterization training	VR vs apprenticeship-based training	N = 27 VR = 11 CG = 15	Sex CG: 13 M, 2 F VR: 5 M, 6 F Age CG: 31 VR: 29	Not mentioned	(i) Mounting the catheter on the guidewire (ii) Cannulating the coronary arteries exchanging catheters (iii) Obtaining and interpreting standard angiographic views (iv) Overall assessment of wire catheter skills (v) Time, efficiency, and ability to complete the case (vi) Need for verbal prompts (vii) Attending take over	Skills required to perform cardiac catheterization can be learned via mentored simulation training
Chuang et al., 2006 [47]	Taiwan	Physical therapy	Patients undergoing CABG	Physical rehabilitation	VR vs usual rehabilitation	N = 20 VR = 10 CG = 10	Sex: 20 M Age CG: 63.70 ± 10.03 VR: 65.70 ± 14.48	2 times a week for about 3 months (30 min)	(i) Heart rate (ii) VO2max (iii) Treadmill grades and speeds (iv) Blood pressure	This study showed a powerful effect of VR on the progress of cardiac rehabilitation
Chuang et al., 2005 [48]	Taiwan	Archives of physical medicine and rehabilitation	Patients undergoing CABG	Physical rehabilitation	VR vs usual rehabilitation	N = 32 VR = 17 CG = 15	Sex CG: 13 M, 2 F VR: 15 M, 2 F Age CG: 68.67 ± 12.32 VR: 64.41 ± 7.66	2 times a week for about 3 months (30 min)	(i) Heart rate (ii) Blood pressure (iii) Rating of perceived exertion (iv) VO2max	Treadmill training enhanced by VR was superior to conventional exercise protocols for post-CABG patients

CHD: coronary heart disease; CR: cardiac rehabilitation; CG: control group; EG: experimental group; CAD: coronary artery disease; CABG: coronary artery bypass graft; EMG: early mobilization group; IHD: ischemic heart disease; AF: atrial fibrillation; ACLS: advanced cardiac life support; HFS: high-fidelity simulation; CCU: cardiac care unit; 6MWT: 6-minute walk test; VRBT: virtual reality-based therapy.