iRhythm Technologies (IRTC) Q4 2025 earnings summary

Executive summary

• Achieved record 2025 revenue of $747.1M, up 26.2% year-over-year, with five consecutive quarters above 20% growth, driven by strong volume across all channels and record commercial adoption.

• Delivered first-ever positive free cash flow and positive quarterly GAAP net income in Q4 2025, marking a key profitability milestone.

• Expanded market presence in primary care, integrated delivery networks, and international markets, commercializing in six markets and advancing new product innovations.

• Advanced EHR integration, with over half of volume through integrated accounts and 75 of top 100 customers fully integrated.

• Strengthened predictive AI capabilities, piloting programs with >85% accuracy in pre-identifying arrhythmia risk and signing a partnership for AI-driven patient risk identification.

Financial highlights

• Q4 2025 revenue: $208.9M, up 27.1% year-over-year; full year 2025 revenue: $747.1M, up 26.2%.

• Q4 gross margin: 70.9% (+90 bps YoY); full year gross margin: 70.6% (+170 bps YoY); Q4 gross margin also reported at 71.2%.

• Q4 net income: $5.6M ($0.17/share), first positive quarterly net income; full year net loss: $44.6M ($1.39/share).

• Q4 adjusted EBITDA: $34.3M (16.4% margin); full year adjusted EBITDA: $68.9M (9.2% margin).

• Free cash flow: $14.5M in Q4, $34.5M for 2025; year-end cash and equivalents: $583.8M.

Outlook and guidance

• 2026 revenue guidance: $870M–$880M (16–18% YoY growth), driven by volume across core, AT, innovative, and international channels.

• Q1 2026 revenue expected at $193M–$195M, reflecting typical seasonality.

• 2026 adjusted EBITDA margin guidance: 11.5–12.5%; Q1 2026: 3–4%.

• Gross margin expected to improve by 80–100 bps in 2026.

• Free cash flow expected to grow in 2026, weighted to the second half.