Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial.

INTRODUCTION: This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups. METHODS: A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination. RESULTS: Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time. CONCLUSION: Access to 360°VCE can reduce patients' pre-CCTA anxiety levels. IMPLICATIONS FOR PRACTICE: The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.

Patient Preferences for Coronary CT Angiography with Stress Perfusion, SPECT, or Invasive Coronary Angiography.

Background Patient preference is pivotal for widespread adoption of tests in clinical practice. Patient preferences for invasive versus other noninvasive tests for coronary artery disease are not known. Purpose To compare patient acceptance and preferences for noninvasive and invasive cardiac imaging in North and South America, Asia, and Europe. Materials and Methods This was a prospective 16-center trial in 381 study participants undergoing coronary CT angiography with stress perfusion, SPECT, and invasive coronary angiography (ICA). Patient preferences were collected by using a previously validated questionnaire translated into eight languages. Responses were converted to ordinal scales and were modeled with generalized linear mixed models. Results In patients in whom at least one test was associated with pain, CT and SPECT showed reduced median pain levels, reported on 0-100 visual analog scales, from 20 for ICA (interquartile range [IQR], 4-50) to 6 for CT (IQR, 0-27.5) and 5 for SPECT (IQR, 0-25) (P < .001). Patients from Asia reported significantly more pain than patients from other continents for ICA (median, 25; IQR, 10-50; P = .01), CT (median, 10; IQR, 0-30; P = .02), and SPECT (median, 7; IQR, 0-28; P = .03). Satisfaction with preparation differed by continent and test (P = .01), with patients from Asia reporting generally lower ratings. Patients from North America had greater percentages of "very high" or "high" satisfaction than patients from other continents for ICA (96% vs 82%, respectively; P < .001) and SPECT (95% vs 79%, respectively; P = .04) but not for CT (89% vs 86%, respectively; P = .70). Among all patients, CT was preferred by 54% of patients, compared with 18% for SPECT and 28% for ICA (P < .001). Conclusion For cardiac imaging, patients generally favored CT angiography with stress perfusion, while study participants from Asia generally reported lowest satisfaction. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Woodard and Nguyen in this issue.

Prevalence and impact of scan-related anxiety during coronary CT angiography: A prospective cohort study of 366 patients.

BACKGROUND: Scanxiety, the anxiety/stress associated with an imaging test, has never been evaluated in relation to coronary CT angiography (Coronary CTA). As it could impact heart rate and thereby affect image quality of Coronary CTA, we aimed to evaluate the prevalence, severity, and impact of scanxiety on quality and interpretability of Coronary CTA. METHODS: 366 consecutive patients were prospectively presented with a clinical questionnaire comprising two tests to evaluate their scan-related anxiety: the Impact of Event IES-6 (6 questions, final score 0-24) and a visual stress-scale (1 question, score 1-10). Patient demographics, heart rate and final image quality scored by two readers were recorded. Potential independent correlations were sought between IES-6 scanxiety level and image quality, heart rate variability and demographics, using an ordinal logistic regression model. RESULTS: 344 patients (59.9% men, 57.6 ±â€¯10.7yo) completed the questionnaire. 74.1% (255 patients) reported some scan-related distress, with a mean IES-6 score of 4.1 ±â€¯4.3 (range 0-18). There was no significant difference in terms of age, sex or indications for Coronary CTA between the non-anxious (IES-6 = 0) and the anxious (IES-6>0) patients. There was no significant independent correlation between image quality and IES-6 score (OR = 0.98, p = 0.62), nor between IES-6 score and heart rate variability (effect = -0.005, p = 0.97). CONCLUSION: The prevalence of scan-related anxiety - aka scanxiety - in Coronary CTA patients is high (74.1%) but does not appear to impact image quality and interpretability.