Studies investigating the diagnostic performance of NT-proBNP have mainly been conducted in relatively small, selected patient cohorts, limiting the generalisability of study findings across clinically important subgroups, such as older patients and those with renal disease or obesity, characteristics that are becoming increasingly prevalent in patients with heart failure.9, 10, 11 Statistical modelling approaches that incorporate patients’ characteristics to provide a more individualised assessment may have more consistent diagnostic performance across patient subgroups.12 This evidence concerns the gene NPPB and obesity due to melanocortin 4 receptor deficiency.