BACKGROUND: Coronary artery bypass grafting (CABG) is one of the most effective treatments for improving the quality of life in patients with severe coronary artery disease. However, these patients face multiple challenges prior to surgery. This study aims to elucidate the challenges faced by cardiac patients before CABG. METHODS: This qualitative study used a conventional content analysis approach. Data were obtained from 26 interviews with 23 individuals, including patients and their families, physicians, and nurses from hospitals in Bushehr and Hamadan, selected through purposive sampling. Data were collected through semi-structured interviews over ten months and analyzed using MAXQDA20 software. RESULTS: A total of 575 initial codes were extracted from the interviews and categorized into 16 subcategories based on similarities and differences. After reviewing and comparing the subcategories, five main categories of challenges faced by cardiac patients prior to coronary artery bypass surgery were identified and conceptually named. These categories included psychological and social stress during the waiting period, financial resource management for treatment, quality of information and communication, heightened need for belonging, and spirituality. CONCLUSIONS: Patients prior to coronary artery bypass grafting encounter psychological, financial, social, and spiritual challenges. A precise understanding of these challenges and the provision of psychological and social counseling to patients and their families, financial support and facilitation of treatment costs, improvement of information quality and communication between patients and the healthcare team, strengthening emotional support from family and friends, and attention to patients' spiritual needs by the healthcare team can facilitate decision-making and enhance the quality of life and surgical outcomes.