Sign in

You're signed outSign in or to get full access.

HI

Heartflow, Inc. (HTFL)·Q4 2025 Earnings Summary

Executive Summary

  • Q4 2025 results are not yet filed; Street models revenue ~$46.24M and EPS -$0.16, with four covering estimates; target price consensus is $38.6, five estimates. These will be the yardsticks for the upcoming print.* Values retrieved from S&P Global.
  • Management initiated FY 2025 revenue guidance at $173.0–$173.5M, reflecting ~37.5–38.0% YoY growth; Q3 delivered strong execution with $46.3M revenue (+41% YoY) and 76.5% GAAP gross margin .
  • Q4 is set to be the final quarter burdened by non-cash warrant remeasurement (~$9.3M expected), simplifying GAAP optics thereafter; company finished Q3 with $291.2M cash and no debt, strengthening flexibility into 2026 .
  • Commercial catalysts: expanded plaque coverage (UnitedHealthcare & Cigna), CMS Category 1 CPT for Plaque effective Jan 1, 2026, and PCI Navigator planned launch in 2026, underpinning the next growth wave .
  • Watch DOJ Civil Investigative Demand (Oct 2025) related to Anti-Kickback/False Claims—management cooperating; potential business impact remains uncertain .

What Went Well and What Went Wrong

What Went Well

  • Durable FFRCT adoption and installed base expansion drove Q3 revenue up 41% YoY to $46.3M; CEO: “We believe we are well-positioned to expand our market leadership” .
  • Margin execution improving: GAAP gross margin 76.5% (non-GAAP 76.8%); CFO cited benefits from algorithm automation and volume leverage, expecting similar margins in Q4 and potential to reach ≥80% over time .
  • Plaque momentum: UHC and Cigna began coverage Oct 1 (57% covered lives); next-gen Plaque received 510(k) with 21% detection improvement and expanded nomogram; DECIDE registry showed management changes in >50% of cases vs CCTA alone .

What Went Wrong

  • GAAP optics remain noisy: Q3 net loss -$50.9M on non-cash items (warrant remeasurement $32.1M, derivative liability +$4.8M benefit, loss on extinguishment of debt -$6.4M); Q4 will carry a final ~$9.3M warrant charge .
  • Operating expenses elevated as Heartflow invests for growth (Q3 GAAP OpEx $50.5M; non-GAAP $46.7M), with headcount expansion (TAM doubling by YE25) dampening near-term EBITDA .
  • Regulatory overhang: DOJ Civil Investigative Demand received Oct 2025 regarding provider arrangements and sales/marketing; outcome and potential financial impact uncertain .

Financial Results

Quarter-over-quarter vs Q4 2025 consensus

MetricQ2 2025Q3 2025Q4 2025 Consensus
Revenue ($USD Millions)43.4 46.3 46.236*
Gross Margin % (GAAP)75.5% 76.5% —
Net Loss ($USD Millions)(9.196)*(50.855) —
Diluted EPS (Reported, $USD)(1.456)*(1.04) —
Primary EPS Consensus Mean ($USD)——(0.15521)*
EBITDA ($USD Millions)(13.32)*(14.80)*(13.822)*
  • Values retrieved from S&P Global.

Year-over-year comparison (Q3 2024 vs Q3 2025)

MetricQ3 2024Q3 2025
Revenue ($USD Millions)32.934 46.276
Gross Margin % (GAAP)75.7% 76.5%
Gross Margin % (Non-GAAP)75.9% 76.8%
Operating Loss ($USD Millions, GAAP)(14.929) (15.099)
Operating Loss ($USD Millions, Non-GAAP)(12.593) (11.139)
Net Loss ($USD Millions, GAAP)(19.140) (50.855)
Net Loss ($USD Millions, Non-GAAP)(16.219) (13.236)
Adjusted EBITDA ($USD Millions)(11.204) (9.835)

Segment / Geography (Q3 2025)

GeographyQ3 2025 Revenue ($USD Millions)
United States42.946
United Kingdom1.519
Japan1.462
Rest of Europe0.349
Total46.276

(Alternate disclosure: U.S. $42.5; International & Other $3.8 )

KPIs

KPIQ1 2025Q2 2025Q3 2025
Revenue Cases (units)40,336 48,423 51,805

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
Total RevenueFY 2025None$173.0–$173.5MInitiated
Gross Margin (qualitative)Q4 2025None“Similar to Q3”Maintained tone
Cash Flow ProfitabilityWithin 3 years of IPOWithin 3 yearsOn trackMaintained
Warrant RemeasurementQ4 2025Recurring non-cashFinal ~$9.3M in Q4; none thereafterCeases after Q4
Balance Sheet (Debt)Q3 exitTerm loan outstanding (pre-IPO)Zero debt; cash $291.2MImproved

Earnings Call Themes & Trends

TopicPrevious Mentions (Q-2 and Q-1)Current Period (Q3 2025)Trend
AI/technology initiativesNext-gen Plaque 510(k) clearance announced Sept 2025; investor outreach 21% plaque detection improvement; expanded nomogram; unveiled PCI Navigator at TCT; 2026 launch plan Strengthening
Product performance (FFRCT/Plaque)Preliminary Q2: revenue ~$43.4M; GM ~75.5% Q3: FFRCT durable; cases +48% YoY; plaque interest rising; clinic volumes strengthening Durable growth
Reimbursement/coverageCommercial coverage building (UHC, Cigna)UHC/Cigna coverage; plaque covered lives 57%; CMS Category 1 CPT 1/1/26 Positive
Regional trendsNot detailedU.S. +42% YoY; OUS & other +24% YoY; total +41% YoY Positive
R&D / clinical evidenceAHA late-breaking plaque staging (FISH & CHIPS) data preview DECIDE registry: management changes >50% vs CCTA alone; AHA FISH & CHIPS late-breaker underscores prognostic value Building evidence
Regulatory/legal—DOJ CID received Oct 2025; cooperating; outcome uncertain New overhang

(Note: There is no Q4 2025 call/transcript available yet; “Current Period” reflects Q3 2025.)

Management Commentary

  • CEO: “Durable growth in our FFRCT business and rapid expansion of our installed base drove third quarter total revenue up 41% year-over-year…With continued business momentum and a strengthened balance sheet following our IPO, we believe we are well-positioned to expand our market leadership” .
  • CFO: “We expect gross margins to be similar to what we saw in 3Q…these margins can move around sequentially, but a lot of the benefits that we saw will persist into 4Q…we’re on track to achieve cash flow profitability within three years of our IPO” .
  • CEO on Plaque: “We don’t believe we’re going to see material adoption until [covered lives] gets north of 70%…I would not advise any material adoption until the tail end of 2026” .
  • CEO on platform strategy: “We’re the only company with offerings that span the full CAD continuum, from detection to diagnosis to management and now to treatment planning” .

Q&A Highlights

  • Growth drivers and guide philosophy: Installed base expansion and referral activation underpin FFRCT growth; Q4 guide embeds conservatism after a strong Q3; look for similar GM in Q4 .
  • Plaque adoption gating factors: Coverage needs to exceed ~70% of lives and physician education (DECIDE-driven) must mature; material impact expected tail-end 2026 .
  • Sales force expansion: TAM team doubling by YE25; framed as market development (pharma-like) rather than transactional medtech selling; productivity ramps over time .
  • PCI Navigator strategic role: Engages interventional cardiologists with pre-procedural planning insights; part of 2026 launch plan to deepen account penetration .
  • Capital and balance sheet: Net IPO proceeds (~$332M) and debt prepayment give flexibility to invest down the P&L while targeting profitability within three years of IPO .

Estimates Context

  • Q4 2025 S&P Global consensus: revenue $46.236M; Primary EPS -$0.155; EBITDA -$13.822; four estimates for revenue/EPS; target price $38.6 (five estimates).* Values retrieved from S&P Global.
  • Implications: With CFO signaling Q4 gross margin similar to Q3 and final warrant charge (~$9.3M), Street will parse non-GAAP profitability trajectory and operating leverage into 2026; any upside from installed base additions and clinic-channel mix could push revenues above the ~$46M bar .

Key Takeaways for Investors

  • Expect a clean-up quarter: Q4 should carry the final warrant remeasurement (~$9.3M), after which GAAP optics improve materially .
  • Near-term setup: Consensus bars are modest (~$46.2M revenue, EPS -$0.16); margin tone suggests similar GM to Q3—solid print would support estimate stability or modest upward revisions.* Values retrieved from S&P Global .
  • Structural growth: FFRCT remains durable; clinic volumes rising; installed base expanding—these should continue to drive case growth into early 2026 .
  • 2026 catalysts: Plaque adoption inflection tied to ≥70% coverage and physician education; PCI Navigator launch could accelerate interventional engagement .
  • Balance sheet strength: ~$291M cash, zero debt post-Q3—ample runway to invest in sales force, automation, and evidence generation through profitability .
  • Risk monitor: DOJ CID introduces regulatory uncertainty; watch for updates, though management is cooperating and impact remains unquantified .
  • Trading lens: Post-Q4, removal of warrant noise plus continued GM discipline could shift focus to operating leverage and 2026 growth drivers (Plaque/PCI), making guidance cadence and covered-lives updates key stock catalysts .
Note on data sources: 
- Document-based figures are cited in brackets [document_id:chunk_idx]. 
- Asterisk (*) indicates values retrieved from S&P Global (GetFinancials/GetEstimates).