Health Risk Reduction and Functional Restoration Following Coronary Revascularization: A Prospective Investigation Using Dynamic Stage Typology Clustering

Abstract

We identified patterns of coronary-prone behavior modification in a prospective cohort investigation of health risk reduction following coronary artery bypass graft (CABG) revascularization surgery. Fifty coronary heart disease (CHD) patients scheduled for bypass answered questions about Transtheoretical Model (TTM) change strategy (process) use, mood, and quality of life at 1 month prior to CABG and again at 1-month and 8-month postsurgery. We grouped participants by stage of readiness to modify a single CHD risk factor (diet, weight, or stress) rated as most problematic at baseline. We constructed two dynamic stage typology clusters to track risk factor reduction over time: a progressing profile (64%) reflected movement to the action or maintenance stage, and a nonprogressing pattern (36%) showed either an absence of movement or relapse. We explored contributions of health status, dispositional optimism, and control appraisals to risk factor reduction. Consistent with previous smoking cessation research, TTM construct measures were highly sensitive to stage typology differences. Nonprogressors overutilized certain cognitive–experiential processes, and progressors demonstrated higher reliance on behavioral change strategies compared to nonprogressors. Progression toward risk factor reduction correlated with decreased postoperative angina, better emotional adjustment, and greater life satisfaction. Dispositional optimism predicted positive affect, a decrease in angina, and a progressing stage profile. Control appraisals did not relate to risk factor reduction.