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

  • Terence E. Fitzgerald
  • James O. Prochaska
  • Glenn S. Pransky
Article

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.

coronary heart disease risk factors prevention Transtheoretical Model cluster analysis 

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REFERENCES

  1. Affleck, G., Tennen, H., Croog, S., and Levine, S. (1987a). Causal attribution, perceived benefits, and morbidity after a heart attack: An 8-year study. J. Consult. Clin. Psychol. 55: 29-35.Google Scholar
  2. Affleck, G., Tennen, H., Croog, S., and Levine, S. (1987b). Causal attribution, perceived control, and recovery from a heart attack. J. Soc. Clin. Psychol. 5: 339-355.Google Scholar
  3. Affleck, G., Tennen, H., Pfeiffer, C., and Fifield, J. (1987). Appraisals of control and predictability in adapting to a chronic disease. J. Person. Soc. Psychol. 53: 273-279.Google Scholar
  4. American Heart Association (1995). Heart and Stroke Facts, American Heart Association, Dallas.Google Scholar
  5. Anderson, E. A. (1987). Preoperative preparation for cardiac surgery facilitates recovery, reduces psychological distress, and reduces the incidence of acute postoperative hypertension. J. Consult. Clin. Psychol. 55: 513-520.Google Scholar
  6. Bairey-Merz, C. N., Rozanski, A., and Forrester, J. (1997). The secondary prevention of coronary artery disease. Am. J. Med. 102: 572-581.Google Scholar
  7. Bandura, A. (1989). Social Learning Theory, Prentice-Hall, Englewood Cliffs, NJ.Google Scholar
  8. Bolman, C., and de Vries, H. (1998). Psychosocial determinants and motivational phases in smoking behavior of cardiac inpatients. Prev. Med. 27: 738-747.Google Scholar
  9. Davis, K. B., Chaitman, B., Ryan, T., Bittner, V., and Kennedy, J. W. (1995). Comparison of 15-year survival for men and women after initial medical or surgical treatment for coronary artery disease: A CASS registry study. J. Am. Coll. Cardiol. 25: 1000-1009.Google Scholar
  10. DiClemente, C. C., and Prochaska, J. O. (1998). Toward a comprehensive transtheoretical model of change: Stages of change and addictive behaviors. In Miller, W. R., and Heather, N. (eds.), Treating Addictive Behaviors, 2nd edn., Plenum Press, New York, pp. 3-24.Google Scholar
  11. Fitzgerald, T. E., and Prochaska, J. O. (1990). Nonprogressing profiles in smoking cessation: What keeps people refractory to self-change? J. Subst. Abuse 2: 87-105.Google Scholar
  12. Fitzgibbon, G. M., Katka, H. P., Leach, A. J., Keon, W. J., Hooper, D., and Burton, J. R. (1996). Coronary bypass graft fate and patient outcome: Angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J. Am. Coll. Cardiol. 28: 616-626.Google Scholar
  13. Fontaine, K. R., and Cheskin, L. J. (1999). Optimism and obesity treatment outcomes. J. Clin. Psychol. 55: 141-143.Google Scholar
  14. Gattuso, S. M., Litt, M. D., and Fitzgerald, T. E. (1992). Coping with gastrointestinal endoscopy: Self-efficacy enhancement and coping style. J. Consult. Clin. Psychol. 60: 133-139.Google Scholar
  15. Gillum, B. S., Graves, E. J., and Kozak, L. J. (1996). Trends in hospital utilization: U.S. In Vital Health Statistics, Vol. 13, DC. NCHS, Washington.Google Scholar
  16. Hegelson, V. S., and Fritz, H. L. (1999). Cognitive adaptation as a predictor of new coronary events after percutaneous transluminal coronary angioplasty. Psychosom. Med. 61: 488-495.Google Scholar
  17. Hemenway, D., Sherman, H., Mudge, G. H., Flatley, M., Lindsey, N. M., and Goldman, L. (1985). Comparative costs versus symptomatic and employment benefits of medical and surgical treatment of stable angina pectoris. Med. Care 23: 133-141.Google Scholar
  18. Linden, W., Stossel, C., and Maurice, J. (1996). Psychosocial interventions in patients with coronary artery disease. Arch. Intern. Med. 156: 745-752.Google Scholar
  19. Litt, M. D., Tennen, H., Affleck, G., and Klock, S. (1992). Coping and cognitive factors in adaptation to in vitro fertilization failure. J. Behav. Med. 15: 171-187.Google Scholar
  20. Mayou, R., and Bryant, B. (1987). Quality of life after coronary artery surgery. Q. J. Med. 62: 239-248.Google Scholar
  21. Motwani, J. G., and Topol, E. J. (1998). Aortocoronary saphenous vein graft disease: Pathogenesis, predisposition, and prevention. Circulation 97: 916-931.Google Scholar
  22. Murray, C. J., and Lopez, A. D. (1997). Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 349: 1269-1276.Google Scholar
  23. Nigg, C. R., Burbank, P. M., Padula, C., Dufresne, R., Rossi, J. S., Velicer, W. F., Laforge, R. G., and Prochaska, J. O. (1999). Stages of change across ten health risk behaviors for older adults. Gerontologist 39: 473-482.Google Scholar
  24. Norman, G. J., Velicer, W. F., Fava, J. L., and Prochaska, J. O. (1998). Dynamic typology clustering within the stages of change for smoking cessation. Addict. Behav. 23: 139-153.Google Scholar
  25. Norman, G. J., Velicer, W. F., Fava, J. L., and Prochaska, J. O. (2000). Cluster subtypes within stages of change in a representative sample of smokers. Addict. Behav. 25: 183-204.Google Scholar
  26. Ornish, D., Brown, S., Scherwitz, L., Billings, G., Armstrong, W., and Ports, T. (1990). Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336: 129-133.Google Scholar
  27. Prochaska, J. O. (1996). A stage paradigm for integrating clinical and public health approaches to smoking cessation. Addict. Behav. 21: 721-732.Google Scholar
  28. Prochaska, J. O., and DiClemente, C. C. (1985). Common processes of self-change in smoking, weight control, and psychological distress. In Shiffman, S., and Wills, T. (eds.), Coping and Substance Use, Academic Press, New York, pp. 184-218.Google Scholar
  29. Prochaska, J. O., and DiClemente, C. C. (1992). Stages of change in the modification of problem behaviors. In Hersen, M., Eisler, R. M., and Miller, P. M. (eds.), Progress in Behavior Modification, Sage, Newbury Park, CA, pp. 184-218.Google Scholar
  30. Prochaska, J. O., DiClemente, C. C., Velicer, W. F., Ginpil, S. E., and Norcross, J. C. (1985). Predicting change in smoking status for self-changers. Addict. Behav. 10: 395-406.Google Scholar
  31. Prochaska, J. O., Velicer, W. F., DiClemente, C. C., and Fava, J. (1988). Measuring the processes of change: Applications to the cessation of smoking. J. Consult. Clin. Psychol. 56: 520-528.Google Scholar
  32. Prochaska, J. O., Velicer, W. F., Guadagnoli, E., Rossi, J. S., and DiClemente, C. C. (1991). Patterns of change: Dynamic typology applied to smoking cessation. Multivar. Behav. Res. 26: 83-107.Google Scholar
  33. Prochaska, J. O., Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski, W., Fiore, C., Harlow, L. L., Redding, C. A., Rosenbloom, D., and Rossi, S. R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychol. 13: 39-46.Google Scholar
  34. Radley, A., and Green, R. (1985). Styles of adjustment to coronary graft surgery. Soc. Sci. Med. 20: 461-472.Google Scholar
  35. Rubenstein, E., and Federman, D. O. (1987). Scientific American Medicine, Scientific American, New York.Google Scholar
  36. Scheier, M. F., and Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychol. 4: 219-247.Google Scholar
  37. Scheier, M. F., and Carver, C. S. (1992). Effects of optimism on psychological and physical well-being: Theoretical overview and empirical update. Cogn. Ther. Res. 16: 201-228.Google Scholar
  38. Scheier, M. F., Carver, C. S., and Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. J. Person. Soc. Psychol. 67: 1063-1078.Google Scholar
  39. Scheier, M. F., Matthews, K. A., Owens, J., Magovern, G. L., Lefebvre, R. C., Abbott, R. A., and Carver, C. S. (1989). Dispositional optimism and recovery from coronary artery bypass surgery. J. Person. Soc. Psychol. 57: 1024-1040.Google Scholar
  40. Sergeant, P., LeSaffre, E., Flameng, W., and Suy, R. (1986). Howpredictable iswork resumption after aortocoronary bypass surgery? Acta Cardiol. 41: 41-52.Google Scholar
  41. Stanton, A. L., and Snider, P. R. (1993). Coping with a breast cancer diagnosis: A prospective study. Health psychol. 12: 16-23.Google Scholar
  42. Voors, A. A., van Brussel, B. L., Thijs-Plokker, H. W., Ernst, S. M., Ernst, N. M., Koomen, E. M., Tijssen, J. G., and Vermeullen, F. E. (1996). Smoking and cardiac events after venous coronary bypass surgery: A 15-year follow-up study. Circulation 93: 42-47.Google Scholar
  43. Wallner, S., Watzinger, N., Lindschinger, M., Smolle, K. H., Toplak, H., Eber, B., Dittrich, P., Elmadfa, I., Klein, W., Krejs, G. J., and Wascher, T. C. (1999). Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty. Eur. J. Clin. Invest. 29: 372-379.Google Scholar
  44. Wallston, K., and Wallston, B. (1978). Development of the Multidimensional Health Locus of Control scales. Health Educ. Monogr. 6: 160-170.Google Scholar
  45. Watson, D., Clark, L. A., and Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS Scale. J. Person. Soc. Psychol. 54: 1063-1070.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Terence E. Fitzgerald
    • 1
  • James O. Prochaska
    • 2
  • Glenn S. Pransky
    • 3
    • 2
  1. 1.Center for Occupational RehabilitationAsheville
  2. 2.Cancer Prevention Research CenterUniversity of Rhode IslandKingston
  3. 3.Liberty Mutual Center for Disability ResearchHopkinton

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