Heartflow (HTFL) Q4 2025 earnings summary

Executive summary

• Achieved record Q4 revenue of $49.1 million, up 40% year-over-year, and $176.0 million for the full year, with global case growth of nearly 53%.

• Installed base expanded by 340 new accounts in 2025, ending with 1,465 U.S. accounts and 489 Plaque Analysis accounts, the strongest new account growth to date.

• Plaque Analysis adoption accelerated, with strong early feedback and expectations to reach 1,000 accounts by year-end 2026.

• Launched next-generation plaque algorithm and announced early launch of PCI Navigator, an AI-driven planning tool, for April 2026.

• Category One CPT code for Plaque effective January 2026, enabling physician reimbursement and coverage for 75% of U.S. covered lives.

Financial highlights

• Q4 revenue was $49.1 million, up 40% year-over-year; U.S. revenue grew 41% to $44.8 million.

• Q4 non-GAAP gross margin reached nearly 80%, up from 75.3% in Q4 2024; full year gross margin was 76.8%.

• Q4 operating loss was $12.5 million (non-GAAP), improved from $13.5 million last year.

• Non-GAAP net loss was $9.8 million ($0.12/share) in Q4, improved from $18.6 million ($3.15/share); full year non-GAAP net loss was $59.9 million ($1.62/share).

• Ended Q4 with $280.2 million in cash equivalents and investments.

Outlook and guidance

• 2026 revenue guidance of $218–$222 million, representing 24–26% year-over-year growth.

• Plaque revenue expected at $15–$17 million in 2026, weighted to the second half.

• 2026 non-GAAP gross margin guidance of 80–81%, up 300–400 basis points year-over-year.

• Increased midterm non-GAAP gross margin target to 85% from 80%.

• On track to achieve cash flow profitability within three years of IPO.