Exploring the potential of extended reality in patient education results of the xheart-study

Effective management of chronic heart failure (CHF) requires comprehensive care strategies, incl. high-quality patienteducation and technology-supported interventions. Although, patienteducation is associated with improved self-management and treatment adherence, implementation in routine practice is often challenged by barriers such as limited consultation time, language-related constraints, and cognitive decline. Extended Reality (XR), incl. Virtual (VR) and Augmented Reality (AR), may offer immersive, interactive modalities to enhance patient understanding, reduce anxiety, and support adherence in chronic disease management. However, successful integration in clinical workflows depends on addressing practical constraints, provider acceptance and multidisciplinary alignment. The XheaRt study explored the role of XR in heart failure education through a user-centred, three-phase approach: mapping current educational practices and needs among healthcare professionals (HCP), exploring attitudes, expectations, and perceived barriers/facilitators regarding XR among patients and HCP, and evaluating the usability and acceptability of three XR Proof-of-Concept (PoC) solutions: screen-based, VR, and AR.

A mixed-methods design was employed. Current educational practices were examined using thematic analysis following Braun and Clarke. Attitudes and expectations towards XR were assessed in a user study involving prototype demonstrations and semi-structured interviews, which were analysed thematically. Usability and acceptability of three XR PoCs were evaluated by assessing patient knowledge pre- and post-intervention and collecting feedback from patients and healthcare professionals on feasibility, attractiveness, and usability through surveys.

Analysis of current educational practices yielded six overarching themes: identification, formal care organisation, patient journey, education, technology, and future aspirations. Both patients and healthcare professionals perceived the XR prototypes as appealing, understandable, and usable, while also highlighting implementation barriers, including time demands, costs, and unfamiliar terminology. Interview data further indicated expectations regarding outcomes and social support, facilitating factors, fear, trust in data security, knowledge, and self-efficacy. Patient knowledge significantly improved after education with the XheaRt PoCs, which were generally rated as acceptable, user-friendly, and appealing. Healthcare professionals who tested the VR tool reported slightly more negative attitudes compared with those evaluated the AR or screen-based PoCs.

XR-based educational tools appear promising to enhance patient education for individuals with chronic conditions such as CHF. To maximise clinical impact, implementation should be accompanied by structural support for healthcare professionals and the development of accessible, workflow-compatible educational materials.