Introduction
Despite improvements in congestive heart failure (CHF) treatment, the prognosis is poor (1). Mortality rates from CHF are analogous to many cancers i.e. five year mortality rate of 50%, rising to a 50% mortality within one year in severe heart failure (2). For moderate to severe heart failure the prognosis is worse than that of breast or prostatic cancer (3). It has recently been shown that the provision of pharmaceutical care to CHF patients can improve clinical and humanistic outcomes (4). The aim of the present study is to, in a randomised controlled trial, evaluate the impact of the provision of structured pharmaceutical care to patients (with a diagnosis of CHF) who attend a hospital outpatient clinic in the UAE.

Methods
This ongoing study is being carried out in the Al-Ain Hospital, a large tertiary referral centre. Patients with a diagnosis of CHF, agreeing to participate in the study, are assigned to a control or intervention group, using restricted randomisation (5) i.e. matched for CHF severity, renal function, concomitant illness and cognitive status. Control patients receive normal treatment, which does not involve interventions by a clinical pharmacist. Intervention patients receive structured pharmaceutical care, by a hospital pharmacist, involving optimisation of drug therapy together with education of the patients on their disease state, lifestyle issues and on self-monitoring. Outcome measures (baseline and at 3 monthly intervals) include: body weight, blood pressure, forced vital capacity, two minute walk test and time to walk 25 and 50 metres, and health related quality of life (SF36). The study has received ethical approval.

Results
A total of 210 patients have been recruited (105 control patients and 105 intervention patients). Two patients in the control group have died. All other patients have completed the 6 month assessments and 130 patients have completed the 12 month assessments. Baseline parameters did not differ statistically between the two groups. Preliminary statistical analysis of the outcome data (independent sample t-testing) for the first 6 months of the study, indicate statistically significant (P<0.05) improvements in the intervention group (compared with control group) as follows: two minute walk test (6 months), time to walk 25 metres (6 months), time to walk 50 metres (6 months), forced vital capacity (3 and 6 months) and blood pressure control (6 months). Corresponding data for the SF36 indicate significant improvements in all domains at both 3 and 6 months, with the exception of the general health domain, which became significant at 6 months. Data from patients who have already undergone the 9 and 12 month assessments indicate that the improvements are sustained over these time periods.

Discussion
The study is ongoing and is due to be completed in June 2001. The results to date are very promising, indicating a significant positive impact of pharmaceutical care. The impact seen in UAE patients is greater than that seen in a similar study performed in Northern Ireland (4). Work is ongoing to identify reasons for this international variation.

References

1. Masse, B.M., Shar, N.B. (1997) Am. Heart J.., 133, 703 � 712
2. Hobbs, F.D.R. (1999) Heart, 82 (suppl.4), 8 � 10
3. Watson, .R.D.S., Gibbs, C.R., Lip, G.Y.H. (2000) Brit. Med. J., 320, 236 � 239
4. Varma, S., McElnay, J.C., Hughes, C.M., Passmore, A.P. and Varma, M. (1999) Pharmacotherapy, 19, 860 0 869
5. Gore, S., (1981) Brit. Med. J., 282, 2114 0 2117