Heartflow Q1 Earnings Call Highlights
Heartflow (NASDAQ:HTFL) reported a sharply higher first-quarter revenue total and raised its full-year 2026 outlook, citing strength in its core FFRCT business, faster-than-expected adoption of its Plaque Analysis product and continued expansion of the coronary CT angiography, or CCTA, market.
President and Chief Executive Officer John Farquhar said HeartFlow entered 2026 with “the strongest momentum in our history,” with first-quarter revenue rising 41% year over year to $52.6 million. Global case volume increased 67% to 67,443 cases, according to Chief Financial Officer Vikram Verghese.
Farquhar said four factors drove the quarter: continued FFRCT utilization across the installed base, a record group of new accounts added in 2025 that is ramping as expected, stronger-than-expected Plaque adoption and broader CCTA market growth supported by clinical guidelines and reimbursement.
The company also said it has now helped physicians manage care for more than 650,000 patients worldwide. Farquhar said HeartFlow’s database now includes more than 200 million annotated CCTA images, which he described as a proprietary asset supporting the company’s artificial intelligence development and automation efforts.
Revenue Guidance Raised After Strong First Quarter
HeartFlow raised its full-year 2026 revenue forecast to a range of $228 million to $232 million, representing expected year-over-year growth of 29% to 32%. The company also increased its Plaque-specific revenue outlook to $19 million to $21 million.
Verghese said U.S. revenue in the first quarter grew 42% to $48.3 million, including $3.2 million of Plaque revenue. Outside the U.S. and other revenue increased to $4.3 million.
Non-GAAP gross margin improved to 80.5% from 75.3% in the prior-year quarter. Management raised its full-year non-GAAP gross margin guidance to approximately 81%, citing volume efficiencies, AI-enabled automation and a higher mix of Plaque revenue. Farquhar said the company remains committed to a midterm non-GAAP gross margin target of 85%.
First-quarter non-GAAP operating loss was $15.5 million, compared with $15 million a year earlier. Non-GAAP net loss was $13.3 million, or $0.16 per share, compared with a non-GAAP net loss of $19.2 million, or $3.11 per share, in the first quarter of 2025. On a GAAP basis, net loss was $27.4 million, or $0.32 per share, including a $7.5 million non-cash impairment charge related to facilities optimization and the company’s headquarters relocation to San Francisco.
HeartFlow ended the quarter with $254.9 million in cash, cash equivalents and investments. Verghese said the company believes it is well-capitalized to fund operations through profitability while continuing to invest in research and development and commercial expansion. He reiterated the company’s expectation of reaching cash flow profitability within three years of its IPO, pointing to a mid-2028 timeframe during the Q session.
Plaque Adoption Ahead of Expectations
Farquhar said Plaque Analysis adoption is ahead of the company’s initial expectations, with account activation ahead of schedule and strong early utilization trends. He pointed to a recently published ACC/AHA scientific statement on plaque, increasing payer coverage and clinical and economic evidence presented at the American College of Cardiology meeting in March as factors supporting awareness and demand.
During the Q portion of the call, Farquhar said Plaque coverage had reached 75% of total covered lives as of the end of March. He said the company continues to use its DECIDE data with payers to expand coverage, while also focusing on adding Plaque to its installed base and educating cardiologists on how to use it in patient care.
Farquhar said HeartFlow has held more than 1,000 medical education events focused on Plaque over the last 12 months, generating more than 100,000 physician impressions. He said the company now expects its Plaque installed base to reach approximately 1,200 sites by the end of 2026.
Verghese said the first-quarter Plaque revenue performance was not a pull-forward of future demand, but reflected sustained momentum. He added that Plaque revenue is still expected to be weighted toward the back half of the year as adoption broadens.
On pricing, Verghese said many early Plaque contracts were structured with attractive pricing to accelerate activation and because reimbursement was more limited at the time. He said existing contracts include mechanisms for price increases over time, with more favorable pricing becoming visible in 2027 and beyond.
FFRCT Business Remains Core Growth Driver
Management said the core FFRCT business remained strong, with durable utilization among established customers and healthy ramping from new accounts added in 2025. Farquhar said the 340 accounts added last year represented the largest annual cohort in HeartFlow’s history and are ramping in line with expectations.
Verghese said new accounts generally take about a year to ramp to near full FFRCT utilization, while existing accounts continue to show durable and consistent utilization patterns. He noted that FFRCT is applicable in roughly 33% of CCTAs, meaning maximum FFRCT utilization in an account is approximately one-third of CCTA volume.
The company also reported continued volume strength in the clinic setting, which Verghese described as a rapidly growing and strategically important market segment. He said HeartFlow continues to see adoption of its volume-based rebate pricing structure, which supports higher volume growth even as mix and rebates affect average selling prices.
Platform Expansion Includes PCI Navigator
Farquhar said HeartFlow’s platform now includes four tools: RoadMap, Plaque, FFRCT and PCI Navigator. He described the platform as a unified AI solution spanning coronary artery disease detection, diagnosis, management and treatment planning.
HeartFlow launched PCI Navigator in April. Farquhar said feedback from interventional cardiologists has exceeded expectations, adding that the tool allows physicians to enter the catheterization lab with a pre-procedural plan. He said the company is executing a phased rollout through 2026, with a broader introduction planned in 2027.
In response to an analyst question, Farquhar said HeartFlow is initially targeting the largest PCI hospitals and is not yet disclosing specific adoption metrics for PCI Navigator. He said the company believes the product can make the platform “stickier” and more compelling over time.
Management also discussed its autonomous processing initiative, which entered a pilot phase in the first quarter. Farquhar said the company expects a gradual rollout through the back half of 2026, with a multi-year impact beginning in 2027. The initiative is expected to support HeartFlow’s gross margin expansion targets.
Clinical Programs Aim to Expand Market Opportunity
Farquhar said HeartFlow has built an evidence base that includes more than 625 peer-reviewed publications and more than 200 clinical studies and trials. He said the company’s 5,000-patient NAVIGATE-PCI Registry is ramping, with sites activating and enrollment building. The study is designed to evaluate how an AI-driven pre-procedural planning tool influences PCI strategy and cath lab efficiency.
The company also plans to begin two randomized controlled trials in the second half of 2026 focused on asymptomatic populations: one for patients with prior myocardial infarction or PCI, and another for patients with elevated calcium scores. A third trial focused on patients with prior Plaque is expected to begin in the first half of 2027.
Farquhar said these studies are intended to expand HeartFlow’s U.S. addressable market by approximately $6 billion over time, bringing the total addressable market to $11 billion. He said the company expects this clinical path to help it begin accessing the incremental market opportunity before the end of the decade.
In closing, Farquhar said the first quarter demonstrated that HeartFlow’s platform strategy is translating into financial results, with FFRCT and Plaque Analysis driving volume growth and deeper account-level adoption. Verghese said the updated outlook reflects momentum in the core business and acceleration in Plaque, while management maintained that the company will continue investing in commercial expansion, clinical evidence and product innovation.
About Heartflow (NASDAQ:HTFL)
HeartFlow, Inc (NASDAQ: HTFL) is a medical technology company that develops non-invasive diagnostic solutions for coronary artery disease. The company's core offering translates coronary CT angiography (CTA) data into a patient-specific, three-dimensional physiological model of the coronary arteries. Using advanced image processing and computational modeling, HeartFlow's analysis estimates fractional flow reserve (FFR) values throughout the coronary tree to identify ischemia-producing lesions without the need for invasive pressure-wire measurements.
HeartFlow's cloud-based service integrates with clinical workflows: clinicians submit coronary CTA images and receive a detailed, color-coded 3D map and report that highlights lesion-specific FFR values and physiological impact.
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