Heartflow, Inc. (HTFL) - Q2 2026 10-Q Summary
Business Context and Reporting Period
This report covers the quarterly period ended June 30, 2026. Heartflow, Inc. is a commercial-stage medical technology company providing AI-driven software for non-invasive diagnosis and management of coronary artery disease (CAD). The company operates as a single reporting segment and completed its Initial Public Offering (IPO) in August 2025. As of June 30, 2026, the company had 86,717,381 shares of common stock outstanding.
Key Financial Metrics
| Metric (in thousands) | Q2 2026 | Q2 2025 | 6 Months 2026 | 6 Months 2025 |
|---|---|---|---|---|
| Revenue | $64,082 | $43,424 | $116,669 | $80,629 |
| Gross Profit | $53,190 | $32,778 | $95,354 | $60,719 |
| Gross Margin | 83% | 75% | 82% | 75% |
| Net Loss | $(15,743) | $(9,196) | $(43,123) | $(41,541) |
| Operating Cash Flow | — | — | $(38,681) | $(40,470) |
| Cash & Investments | $246.8 million (as of June 30, 2026) | |||
| Accumulated Deficit | $1.13 billion (as of June 30, 2026) |
Debt & Liquidity: The company has no outstanding term loans or convertible notes as of June 30, 2026, having repaid its 2024 Term Loan and converted 2025 Convertible Notes to equity upon its IPO in August 2025. Total liabilities were $64.7 million, primarily consisting of operating lease liabilities.
Material Changes vs. Prior Period
- Revenue Growth: Revenue increased 48% year-over-year in Q2 2026 and 45% for the six-month period. This was driven by a 74% increase in revenue case volume, aided by the commercialization of Heartflow Plaque Analysis and expanded Medicare reimbursement coverage (CPT code 75577) effective January 1, 2026.
- Expense Increases: Operating expenses rose significantly. Research and Development (R&D) expenses increased 75% in Q2 2026 due to headcount growth. Selling, General, and Administrative (SG&A) expenses increased 42% in Q2 2026, driven by personnel costs and professional fees associated with public company operations.
- Asset Impairment: The company recorded a non-cash asset impairment charge of $7.5 million in Q1 2026 related to the right-of-use asset and leasehold improvements for its Mountain View, California facility following a sublease agreement.
- Interest Income: Interest income increased to $2.3 million in Q2 2026 compared to interest expense in the prior year, reflecting the repayment of debt and higher yields on cash and investments.
Guidance, Outlook, and Risks
- Outlook: Management expects to continue incurring losses in the foreseeable future as it scales operations, invests in R&D, and expands commercial efforts. The company believes its current cash, cash equivalents, and investments ($246.8 million) are sufficient to fund operations for at least the next 12 months.
- Product Pipeline: Heartflow PCI Navigator was launched in April 2026. The company anticipates launching "Plaque Tracker" in 2027 to enable longitudinal plaque analysis.
- Legal Proceedings:
- DOJ Investigation: In October 2025, the company received Civil Investigative Demands (CID) from the U.S. Department of Justice regarding the Anti-Kickback Statute and Civil False Claims Act. The outcome is uncertain and could materially impact the business.
- Patent Litigation: In April 2026, Heartflow filed a patent infringement lawsuit against Cleerly, Inc., alleging infringement of six patents related to its Ischemia, Plaque Analysis, and Compare products.
- Risks: Key risks include dependence on two primary products, reimbursement policy changes, competition, and the ability to achieve profitability. The company is currently an "emerging growth company" but expects to qualify as a "large accelerated filer" by the end of fiscal year 2026.
Investor Verification Checklist
- Reimbursement Status: Verify the current coverage status of Heartflow Plaque Analysis across all seven Medicare Administrative Contractors (MACs) and commercial payors.
- DOJ Investigation: Monitor updates regarding the Department of Justice investigation into financial arrangements and sales activities.
- Impairment Details: Review the specific terms of the Mountain View sublease and the projected impact on future lease costs and occupancy.
- Case Volume vs. Revenue: Analyze the trend in "revenue cases" versus revenue growth to assess pricing pressure from volume rebates and the mix of clinic vs. hospital accounts.
- Patent Litigation: Track the progress of the lawsuit against Cleerly, Inc. and potential impacts on market share or legal costs.