Cardiology

Dr. Abdel-Qadir speaks to a patietn

Heart disease remains a leading cause of death in Canada, particularly for women where the condition has been under-researched, under-treated and under-supported. Variability in screening and quality of care impacts the ability of Canadians to live longer lives free from heart disease.

Our scientists are focused on novel cardiovascular risk factors including influenza infections, fertility treatment and chemotherapy to identify individuals at highest risk and inform treatment guidelines. To address the disparities in women’s cardiac health, we are also developing solutions to close the health gap by tackling risk factors and disease prevention through unique lifestyle interventions.

Dr. Jacob A. Udell

Cardiovascular Outcomes Research Program

Dr. Udell and the Cardiovascular Outcomes Research Program team focuses on studying new treatment strategies in patients with or at risk of coronary heart disease (CHD) and heart failure (HF). In Canada, an estimated 2.6 million adults aged 20 years and older are living with CHD including over half a million with a history of a heart attack. Another approximate 700,000 Canadian adults aged 40 years and older were living with HF. In the US, an estimated 20.1 million adult Americans have CHD and 6 million American adults have HF. The prevalence of both conditions and burden on the health system are projected to increase while outcomes are improving thanks in part to therapeutic advancements.

Dr. Husam Abdel-Qadir

Cardio-Oncology

  • In Canada, breast cancer remains the most common type of cancer in women, while cardiovascular disease is one of the leading causes of death. Cardiovascular disease is also the leading non-cancer cause of death in breast cancer survivors, who have an increased risk of heart disease and stroke because of their cancer treatments. Dr. Abdel-Qadir’s research and clinical focus is on the cardiovascular health of people who are under-represented in clinical trials, particularly women and people with multiple illnesses that introduce competing risks. His aim is to improve medical care for people who face challenges within our healthcare system due to the complexities of their illnesses and address existing knowledge gaps in cardio-oncology research. By developing better pathways of care, he hopes to identify higher-risk women to address modifiable risks to improve their cardiovascular health, as well as lower-risk women to ensure they are spared unnecessary interventions and doctor visits.

Atrial Fibrillation

  • Atrial fibrillation is the most common sustained rhythm disorder, with an incidence that increases steadily as people age beyond 65 years. It substantially increases the risk of stroke. Current guidelines call for life-long treatment with blood thinners for most patients aged over 65 years as their stroke risk is estimated to exceed be 1% per year. However, this means that over 90% of patients will not develop a stroke yet will be exposed to the risk of bleeding as well as the cost and inconvenience of life-long blood thinners. Dr. Abdel-Qadir’s research program involves cardiovascular disease in older adults with a focus on stroke prevention in patients with atrial fibrillation. He plans to use population-based data to better predict the risk of stroke in older patients with atrial fibrillation and to investigate alternate methods of stroke prevention.

Dr. Natasha Aleksova

Dr. Aleksova’s research focuses on evaluating outcomes in patients living with heart failure and after heart transplantation. She is a local co-investigator for DAPA ACT TIMI-HF, a randomized controlled trial of in-hospital initiation of dapagliflozin, and a local co-investigator for AERIAL, a randomized controlled trial of antiplatelet therapy after heart transplantation. Dr. Aleksova was awarded a CDTRP research innovation grant for current work to appraise the available evidence for COVID-19 vaccination strategies in solid organ transplant recipients for the purposes of creating a living systematic review and rapid guideline recommendations. She is also evaluating outcomes in critically ill patients listed urgently for heart transplantation in national listing organ allocation polices.

Dr. Shadi Akhtari

Dr. Akhtari is a staff cardiologist at Women’s College Hospital, Assistant Professor in the Department of Medicine, and a Clinician in Quality and Innovation, University of Toronto. She specializes in advanced cardiac imaging. Apart from clinical practice of general cardiology and multi-modality cardiac imaging, her other areas of interest are prevention, diagnosis, and management of coronary artery disease, particularly in those with underlying inflammatory disease. Her research focuses on improving quality of cardiac care offered to patients with rheumatic disease. She also has an interest in development and evaluation of innovative models of care and healthcare delivery, including evaluation of virtual care in Cardiology.

Dr. Akhtari graduated from Queen’s University School of Medicine and has completed further specialty and subspecialty training in Internal Medicine, Cardiology, and Adult Echocardiography (Level 3 training) at McGill University. She worked as a staff cardiologist at McGill University Health Centre prior to leaving to pursue additional training in Cardiovascular Magnetic Resonance Imaging (Level 3 training) at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, as well as certification in Cardiac Computed Tomography (Level 2 training) from Johns Hopkins Bayview Medical Center, Baltimore, Maryland. Most recently, she has completed a Master’s degree in Quality Improvement and Patient Safety at the University of Toronto Institute for Health Policy, Management and Evaluation. She is a fellow of the Royal College of Physicians and Surgeons of Canada, fellow of the American College of Cardiology and a diplomate of the National Board of Echocardiography.

Dr. Ayodele Odutayo

Dr. Odutayo’s research focuses on the intersection of cardiovascular disease and kidney disease. He is particularly interested in strategies to reduce cardiovascular risk in people with mild to moderate kidney disease. This research area is important to patients and the health system because cardiovascular disease and kidney disease are leading causes of morbidity and mortality. While these conditions can occur separately, they often coexist, resulting in a cycle of interdependent and progressive decline in function in both organ systems. The co-existence of cardiovascular and kidney disease has therefore been acknowledged as a unique clinical entity known as the “cardiorenal syndrome”, which portends a particularly high risk of ischemic heart disease (IHD), heart failure or end-stage renal disease (ESRD); conditions that all contribute to long term morbidity.

Current Observational Research:

  • Statins in people with chronic kidney disease

Dr. Jairo Nunes

  • Heart failure with reduced ejection fraction as a consequence of ischemic heart disease
  • Biomarkers in heart failure and their role in changes in ventricular structure and function in the population with ischemic heart disease
  • Therapies for heart failure with preserved ejection fraction
  • Acute heart failure

Ischemic heart disease is the leading cause of death worldwide and the primary etiology of heart failure. Identifying which patient will have more benefits between myocardial revascularization or medical therapy alone remains a challenge in ischemic heart disease with reduced ejection fraction. The use of new biomarkers may play an essential role in helping the selection of these patients. Heart failure with preserved ejection is associated with high mortality and morbidity. Except for SGLT2 inhibitors, there is a lack of evidence of therapies capable of reducing mortality in this population

Currently Working On:

  • MASS-VI (HF): Hypotheses, rationale, design, and methods for prognostic evaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy who undergo medical or surgical treatment
  • Chronic heart failure outcomes: a population-based analysis from a Brazilian institution: A retrospective cohort study in patients with chronic heart failure to investigate outcomes and explore associated risk and prognostic factors. Leadership Role.
  • COVID-19 Vaccination Strategies in Solid Organ Transplant Recipients: A Systematic Review and Network Meta-Analysis

Bahar Behrouzi

Bahar is a dual MD-PhD candidate at the University of Toronto’s Temerty Faculty of Medicine and the Institute for Health Policy, Management and Evaluation at the Dalla Lana School of Public Health. Through the doctoral program in Clinical Epidemiology, her research focuses on applying epidemiological methods to investigate the intersection between cardiovascular disease and viral respiratory illnesses, with an emphasis on SARS-CoV-2, influenza, and respiratory syncytial viruses, using routinely collected health administrative data (i.e., real world evidence) and global pragmatic trial data. Prior to this, she completed her Master of Science in Global Health Management at McMaster University and an Honours Bachelor of Science in Biochemistry (Specialist) at the University of Toronto.

Maya Sheth

Maya is completing her Masters of Public Health, specializing in Epidemiology, at the Dalla Lana School of Public Health, University of Toronto. Her undergraduate research investigated the real-world impact of implementing the recommendations of a cardiovascular RCT to Ontario clinical practice. Her Master’s research is investigating cardiovascular outcomes and medication adherence among marginalized populations, using the Ontario Marginalization Index.

Aranya Punithan

Aranya is completing her Master of Science in Pharmacology at the University of Toronto. Her research investigates the effect of canagliflozin versus placebo on change in high sensitivity C-reactive protein (hsCRP), a marker of inflammation, and fibroblast growth factor 23 (FGF-23), a marker of mineral metabolism regulation and myocardial fibrosis in the CANagliflozin cardioVascular Assessment Study (CANVAS) trial.

Holly Rector

Holly’s research focuses on enhancing the care of our patients and families through quality improvement and patient safety initiatives. As part of the cardiology program, Holly works with our team to develop and evaluate models of care in heart failure, urgent cardiac conditions and virtual care to ensure that we provide excellent care and enhance the patient experience.

Current Projects:

  • Virtual Clinic for Individuals with Stable Coronary Artery Disease (2021-2023) (*only recruiting internally at this time)
    • Funded by the Women’s College Hospital Academic and Medical Services Group Innovation Fund

This project aims to create a virtual clinic for patients with stable coronary artery disease through a team approach, comprised of a cardiologist, nurse practitioner, and pharmacist.  This efficient, convenient and patient-centered model of care will enable us to care for a larger group of patients and reduce the number of unnecessary in-person visits, particularly in view of the current COVID-19 pandemic.  It also allows for patients with stable disease to be able to continue to be followed by a specialist, rather than being discharged to their primary care provider, likely leading to improved patient satisfaction.  Furthermore, it helps provide access to specialist care to those living in remote areas with limited resources. 

  • Interprofessional Heart Function Clinic (2020-current) (requires referral from physician and must meet certain criteria)
    • Current evaluation of smaller project with the clinic focused on medication optimization funded by small grant from Novartis inc.

Heart failure (HF) predominantly affects older adults over the age of 65 and is associated with increased risk of death, illness, hospitalization and decreased quality of life. After a recent hospitalization for heart failure, individuals are particularly vulnerable and early assessment by a specialist can reduce the risk of ending back up in hospital.  With the implementation of a team-based heart function clinic at WCH, we will aim to provide short-term timely access to follow up and opportunity for the optimization of medical therapy, which will ultimately reduce risk for returning to hospital, reduce risk for medication errors and improve quality of life. My research focuses on ensuring that we are providing timely evidence-based care and comparing our performance to current guidelines.

Cardiovascular Outcomes Research Program

Lead Scientist Dr. Jacob (Jay) Udell, MD, MPH, FRCPC
Research Fellows Dr. Ayodele Odutayo, MD (Nephrology)
Dr. Jairo Nunes, MD (Cardiology)
Research Coordinators Sara Karlsson, CCRP, Research Coordinator I
Libby Leung-Kalman, RN, CCRP, Research Coordinator II
Current Trainees Bahar Behrouzi, 2nd year MD / 4th year PhD Student, Clinical Epidemiology Candidate, Medicine/IHPME, University of Toronto

Brendan Wong, MD, 5th year Cardiology Resident, University of Toronto

Asmaa Abumuamar, MD, 3rd year Internal Medicine Resident, University of Toronto

Aranya Punithan, 2nd year MSc Student, Dept. of Pharmacology and Toxicology,
Faculty of Medicine, University of Toronto

Maya Sheth, 2nd year MPH, Epidemiology Student, IHPME, Faculty of Medicine, University of Toronto


Cardiology Division

Cardiologists/Scientists Dr. Husam Abdel-Qadir, MD, FRCPC, DABIM
Dr. Shadi Akhtari, MD
Dr. Natasha Aleksova, MD
Nurse Practitioners Holly Rector, DNP, RN-EC
Research Staff Faiza Ishrat, Research Assistant II with Dr. Husam Abdel-Qadir

Studies involving our global leadership:

  • EMPACT-MI: A Streamlined, Multicentre, Randomised, Parallel Group, Double-blind Placebo-controlled Superiority Trial to Evaluate the Effect of EMPAgliflozin on Hospitalisation for Heart Failure and Mortality in Patients With aCuTe Myocardial Infarction
  • INVESTED Covid-19 Ancillary Study: INfluenza Vaccine to Effectively Stop cardio Thoracic Events and Decompensated heart failure

Studies involving our national leadership:

  • FINEARTS-HF: A Multicenter, Randomized, Double-blind, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy and Safety of Finerenone on Morbidity and Mortality in Participants with Heart Failure (NYHA II-IV) and Left Ventricular Ejection Fraction ≥ 40% (LVEF ≥ 40%)
  • HIMALAYAS: The Harmonized Interventions to Maintain health via Appropriate risk factor modification and Lifestyle changes in pediatric, Adolescent and Young Adult cancer Survivors trial
  • AERIAL Trial: Early Initiation of Antiplatelet ThERapy In HeArt TranspLantation

Studies in which WCH is a recruiting centre:

  • EMBARK-HFpEF: An Exploratory, Open-label, Proof-of-concept, Phase 2a Study of Mavacamten (MYK-461) in Participants with Heart Failure with Preserved Ejection Fraction (HFpEF) and Chronic Elevation of Cardiac Biomarkers
  • SSACP: The Sex-Specific Assessment of Chest Pain Study
  • VESALIUS: A Double-blind, Randomized, Placebo-controlled, Multicenter Study to Evaluate the Impact of Evolocumab on Major Cardiovascular Events in Patients at High Cardiovascular Risk without Prior Myocardial Infarction or Stroke
  • WISER: Wholesale cardiac Imaging Surveillance with Echocardiography and Radionuclide Angiography during breast cancer chemotherapy
  • CHAMPION-BC: Characterizing Heart And Mind health Post-chemotherapy In wOmeN with Breast Cancer
  • OCEANIC-AF: Oral faCtor Eleven A iNhibitor asundexIan as novel antithrombotiC – Atrial Fibrillation phase 3 study
  • DAPA ACT HF-TIMI 68: A Multicenter, Randomized, Double-Blind, Parallel Group, Placebo-Controlled Trial to Evaluate the Effect of In-Hospital Initiation of Dapagliflozin on Clinical Outcomes in Patients Who Have Been Stabilized During Hospitalization for Acute Heart Failure DAPAgliflozin and Effect on Cardiovascular Events in ACuTe Heart Failure -Thrombolysis in Myocardial Infarction 68 
  • CHOICES: Community Heart Outcomes Improvement and Cholesterol Education Study
  • GOLDILOX: Efficacy and Safety of MEDI6570 in Patients with a History of Myocardial Infarction

Jacob A. Udell, MD, MPH, FRCPC

  • Co-author of following studies

Husam Abdel-Qadir, MD, FRCPC, DABIM

  1. Abdel-Qadir H, Akioyamen LE, Fang J, Pang A, Ha ACT, Jackevicius CA, Alter DA, Austin PC, Atzema CL, Bhatia RS, Booth GL, Johnston S, Dhalla I, Kapral MK, Krumholz HM, McNaughton CD, Roifman I, Tu K, Udell JA, Wijeysundera HC, Ko DT, Schull MJ, Lee DS. Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study. Circulation. 2022 Jun 9(3):159-171. Available from: 10.1161/CIRCULATIONAHA.122.058949. Impact Factor 39.9. Principal Author. This study described disparities in access to care for atrial fibrillation in Ontario. Beyond its clinical applicability to people with atrial fibrillation, it sheds insight into what elements of clinical care are widely accessible in a single-payer healthcare system, and which aspects are inequitably accessed. The importance of this paper is highlighted by being published in one of the highest impact Cardiology journals. 
  2. Abdel-Qadir H, Sabrie N, Leong D, Pang A, Austin PC, Prica A, Nanthakumar K, Calvillo-Argüelles O, Lee DS, Thavendiranathan P. Cardiovascular Risk Associated With Ibrutinib Use in Chronic Lymphocytic Leukemia: A Population-Based Cohort Study. J Clin Oncol. 2021 Nov 1;39(31):3453-3462. Impact Factor 44.5. Principal Author. Ibrutinib is an important treatment for chronic lymphocytic leukemia but comes with an increased risk of a heart rhythm disorder known as atrial fibrillation. This risk has not been well-quantified in routine clinical use. We showed that ibrutinib use was associated with a nearly two-fold increase in the risk of atrial fibrillation, bleeding, and heart failure but was not associated with a higher risk of stroke or myocardial infarction. The ibrutinib-associated bleeding risk was substantially higher in patients who were also treated with anticoagulation. These population-level data confirm signals from prior clinical trials about risk-benefit ratio of ibrutinib and provide a baseline for future cardiac risk comparisons with second-generation Bruton tyrosine kinase inhibitors. 
  3. Abdel-Qadir H, Singh SM, Pang A, Austin PC, Jackevicius CA, Tu K, Dorian P, Ko DT. Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA2DS2-VASc Factors. JAMA Cardiol. 2021 Aug 1;6(8):918-925. 34009232. Impact Factor 14.7. Principal Author. This paper studies the risk of stroke and its association with age in men and women aged 66 to 74 years with atrial fibrillation who do not have congestive heart failure, hypertension, diabetes, stroke, or vascular disease. This is a patient group with limited clinical trial data and discrepant recommendations regarding use of anticoagulation therapy. Our findings suggest that anticoagulation therapy is unlikely to yield net clinical benefit in all-comers but is more likely to do so for older individuals. 
  4. Abdel-Qadir H, Tai F, Croxford R, Austin PC, Amir E, Calvillo-Argüelles O, Ross H, Lee DS, Thavendiranathan P. Characteristics and Outcomes of Women Developing Heart Failure After Early Stage Breast Cancer Chemotherapy: A Population-Based Matched Cohort Study. Circ Heart Fail. 2021 Jul 1;14(7):e008110. 34187164. Impact Factor 8.79. Principal Author. The prognosis of heart failure (HF) after early-stage breast cancer (EBC) treatment with anthracyclines or trastuzumab was not well-characterized before this study, so that patient counselling was driven by the likelihood of cardiotoxicity without a good appreciation of its consequences. We showed that women developing HF after cardiotoxic EBC chemotherapy have fewer comorbidities than cancer-free women with HF and may have better prognosis that matched HF controls. 
  5. Abdel-Qadir H, Thavendiranathan P, Austin PC, Lee DS, Amir E, Tu JV, Fung K, Anderson GM. Development and validation of a multivariable prediction model for major adverse cardiovascular events after early stage breast cancer: a population-based cohort study. Eur Heart J. 2019 Dec 21;40(48):3913-3920. PMID: 31318428. Impact Factor 23.24. Principal Author. This is the first risk model to predict long-term global cardiovascular risk in women with early stage breast cancer. This is a patient group where cardiovascular disease poses an important competing risk making it a factor in systemic cancer treatment decisions. The importance of this work is highlighted by the fact that it was published in the Cardiology Journal with the highest impact factor internationally at that time. It has been cited 48 times since 2019. 
  6. Abdel-Qadir H, Ethier JL, Lee DS, Thavendiranathan P, Amir E. Cardiovascular toxicity of angiogenesis inhibitors in treatment of malignancy: A systematic review and meta-analysis. Cancer Treat Rev. 2017 Feb 1;53(53):120-127. 28104567. Impact Factor 8.89. Principal Author. This is a systematic review that crystallized the spectrum and magnitude of cardiovascular risk associated with this increasingly common class of cancer therapeutics. It has been incorporated in major oncology guidelines and has been cited over 151 times since 2017. 
  7. Abdel-Qadir H, Austin PC, Lee DS, Amir E, Tu JV, Thavendiranathan P, Fung K, Anderson GM. A Population-Based Study of Cardiovascular Mortality Following Early-Stage Breast Cancer. JAMA Cardiol. 2017 Jan 1;2(1):88-93. 27732702. Impact Factor 14.7. Principal Author. This paper provided context as to the magnitude of the competing risks of death from cancer versus cardiovascular disease in women with early stage breast cancer, It was designated as a Highly cited paper by the Web of Science: “As of September/October 2017, this received enough citations to place it in the top 1% of the academic field of Clinical Medicine based on a highly cited threshold for the field and publication year”. It has been cited 195 times since 2017. 

Natasha Aleksova, MD 
Ayodele Odutayo, MD

  1. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.

This is a meta-analysis of 104 cohort studies examining the association between atrial fibrillation, cardiovascular disease and renal disease. The study showed that beyond the well established association between atrial fibrillation (AF) and stroke, AF is associated with an increased risk of heart failure and chronic kidney disease.Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016 Sep 6;354:i4482. doi: 10.1136/bmj.i4482. PMID: 27599725.

  1. AKI and Long-Term Risk for Cardiovascular Events and Mortality

This is a meta-analysis of 25 studies which demonstrated that acute kidney injury is associated with a long term risk of cardiovascular disease and particularly, heart failure.Odutayo A, Wong CX, Farkouh M, Altman DG, Hopewell S, Emdin CA, Hunn BH. AKI and Long-Term Risk for Cardiovascular Events and Mortality. J Am Soc Nephrol. 2017 Jan;28(1):377-387. doi: 10.1681/ASN.2016010105. Epub 2016 Jun 13. PMID: 27297949; PMCID: PMC5198285.

  1. Sodium-Glucose Cotransporter 2 Inhibitors, All-Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta-Analysis and Meta-Regression.

This is a meta-analysis of 53 RCTs which demonstrated that the effect of SGLT-2 inhibitors on cardiovascular outcomes are consistent, irrespective of baseline cardiovascular risk.Odutayo A, da Costa BR, Pereira TV, Garg V, Iskander S, Roble F, Lalji R, Hincapié CA, Akingbade A, Rodrigues M, Agarwal A, Lawendy B, Saadat P, Udell JA, Cosentino F, Grant PJ, Verma S, Jüni P. Sodium-Glucose Cotransporter 2 Inhibitors, All-Cause Mortality, and Cardiovascular Outcomes in Adults with Type 2 Diabetes: A Bayesian Meta-Analysis and Meta-Regression. J Am Heart Assoc. 2021 Sep 21;10(18):e019918. doi: 10.1161/JAHA.120.019918. Epub 2021 Sep 13. PMID: 34514812; PMCID: PMC8649541.Bahar Behrouzi @BaharBehrouzi

  1. Association of Influenza Vaccination With Cardiovascular Risk: A Meta-analysis

In this meta-analysis of 9001 adults who were randomized to influenza vaccination versus matching placebo/standard care, receipt of influenza vaccination was associated with a 34% lower risk of major adverse cardiovascular events — and up to 45% lower risk in those with recent acute coronary syndrome. Given influenza poses an ongoing threat to population health, high-risk patients should be counselled on the cardiovascular benefits of flu vaccines.

  1. Universal flu vaccines: a shot at lifelong cardioprotection?

In this Clinical Outlook, we highlight current and future approaches for using influenza vaccination to reduce the risk of atherosclerotic cardiovascular disease and heart failure, building an argument for why flu vaccines are an indispensable tool in the heart disease armamentarium.

  1. Influenza Vaccination to Reduce Cardiovascular Morbidity and Mortality in Patients With COVID-19: JACC State-of-the-Art Review

In this State-of-the-Art review from early in the SARS-CoV-2 pandemic, we describe mechanistic links between flu infection and COVID-19 – including the risk of acute cardiovascular events – summarizing the data to date on the potential cardioprotective effects of influenza vaccines and guideline recommendations thus far.Maya ShethThis paper examined the eligibility and potential real‐world impact of very low-dose rivaroxaban therapy on the Ontario population. We found that implementation of this therapy would potentially impact 40% of patients with atherosclerotic disease in Ontario.

  1. Association between Marginalization Status and Appropriate Cardiovascular Medication Management- A CANHEART Cohort Analysis

This study is examining the effects of marginalization on cardiovascular outcomes and discontinuation of cholesterol and diabetes medications. The results of this project will add to the gaps in literature regarding racial and socioeconomic disparities in the provision of cardiac care.

  1. Primary Care Clinical Volumes, Cholesterol Testing, and Cardiovascular Outcomes

This study examined the relationship between primary care provider outpatient clinical volumes and cholesterol testing and major adverse cardiovascular event rates among guideline recommended eligible patients.