[Heart failure: old questions, insufficient answers].

38 Studies analyzing compliance with guidelines for clinical practice in numerous syndromes and diseases have proliferated, in a praiseworthy attempt to calibrate the distance that separates theoretical recommendations from the reality of care. Heart failure is not exceptional. In the present number of the journal, García Castelo et al.1 report the results of the INCARGAL study, in which they evaluate the differences in the treatment of the syndrome depending on the department to which the patient is admitted (cardiology or internal medicine and geriatrics) in 14 hospitals of the Community of Galicia.1 The interest of the study lies not only in its contribution to a critical understanding of care in Spain, which is still unsatisfactory, but also in its contribution to the debate that has been aired in the pages of this journal2-5 regarding the specialty or department that is most suitable for the adequate treatment of heart failure. The findings of the study are similar to those of other studies6-8 with respect to trends in the use of diagnostic and therapeutic resources in general, as well as the differences observed in the profile of the patients and patterns of treatment in cardiology and internal medicine departments. A first comment, somewhat marginal, refers to the relative similarity between the findings of different studies (in relation to the most relevant variables), despite the serious limitation of the absence of satisfactory diagnostic criteria for the syndrome that have been developed by consensus. The absence of criteria continues to be an important problem for research and clinical practice, despite the efforts of scientific associations to force the introduction of criteria of this type. If a consensus is reached in the future regarding sensitive, specific, and easily applicable diagnostic criteria for heart failure, without doubt our knowledge of the characteristics of the syndrome will gain in precision. However, it does not seem liED I TO R I A L S