Boston Scientific (BSX) Q4 FY25 earnings call: guidance and Q&A

Expressed concern about U.S. EP being flat sequentially and WATCHMAN missing slightly, given they are key growth drivers. Asked for clarification on Q4 performance versus expectations and how to level set 2026 expectations, noting Street estimates for EP market growth are higher than management's.

Mike Mahoney stated Q4 EP results exceeded internal targets, growing 35% while competitors grew less, suggesting the market grew 18-20% in Q4, not 25%. He acknowledged some share loss was anticipated due to new entrants but expressed confidence in maintaining market leadership. WATCHMAN grew 29%, similar to Q3, and concomitant procedures continue to drive growth. He emphasized the overall company's ability to exceed guidance and consensus.

“We think the market in Q4 was closer to 18% to 20% growth rather than what some other companies have claimed at 25%.”

asked by Robert Marcus · answered by Michael Mahoney

Asked if recent 2025 trials (CLOSURE, ALONE-AF, OCEAN) impacted WATCHMAN and for Dr. Stein to elaborate on CHAMPION trial endpoints and the importance of similar ischemic/hemodynamic stroke rates.

Dr. Stein confirmed no impact from the mentioned trials on WATCHMAN uptake. For CHAMPION, he highlighted two co-primary endpoints: non-inferiority for combined stroke, systemic embolism, and death, and superiority for bleeding. He noted that showing superiority on bleeding, similar to OPTION, would be significant.

“We will be hosting an event for investors on that Saturday night at 5:30 p.m. Central Time, and we can get deep into the data at that point.”

asked by Larry Biegelsen · answered by Ken Stein

Pushed on U.S. EP being flat sequentially while RF competitors grew, suggesting share change. Asked if anything changed late in Q4 and how Q1 guidance (8.5-10%) relates to EP.

Mike Mahoney reiterated consistency in messaging, stating the market grew 18-20% in Q4. He acknowledged anticipated share loss due to new competitors but expressed confidence in maintaining market leadership and growing faster than the 15% market growth expected for 2026. Q1 guidance reflects tough comps and impacts from ACURATE discontinuation (150 bps) and AXIOS product removal.

“When you're the highest market share leader in PFA and competitors are coming out, we planned and we do expect to lose some share given the competitive launches that are coming out and given our really dominant market share position going into 2025.”

asked by Travis Steed · answered by Michael Mahoney

Asked what other products or business units are expected to accelerate in the second half of 2026 and into 2027, beyond EP and WATCHMAN.

Mike Mahoney highlighted expected stronger performance in PI, Urology, Neuromodulation, and CRM in 2026 compared to 2025. He noted the Endoscopy business is strong despite the AXIOS issue, and the Interventional Oncology business is scaled and growing. He also mentioned the coronary business's double-digit growth and new product launches like SEISMIQ IVL and clinical work in hypertension, emphasizing the company's diversified growth drivers.

“We expect to have stronger performance in a number of our business units in '26 versus what we had in '25. We do expect our PI business, our uro business, our neuromod business and our CRM businesses to have stronger years in '26 than they did in '25.”

asked by Joanne Wuensch · answered by Michael Mahoney

Asked about EP lab capacity constraints, given efficiency gains from FARAPULSE are now built-in and growing waitlists for procedures, especially with potential CHAMPION trial positivity. Inquired how this impacts overall market growth.

Dr. Stein acknowledged that efficiency gains are largely integrated, leading to a more realistic 15% EP market growth expectation for 2026. He identified ASC build-out, repurposing cath labs, and continued efficiency drives (e.g., concomitant procedures, Siemens 4D ICE partnership) as keys to unlocking capacity and reducing waitlists. He stressed that until these factors fully play out, market growth exceeding 20% is unlikely.

“But the keys to driving that forward will be, a, starting the build-out of ASCs in the United States to unlock some more capacity and reduce those waiting lists, continued just development and repurposing cath labs for the use for EP procedures in the hospital.”

asked by Danielle Antalffy · answered by Ken Stein

Noted the 70% PFA penetration in AF cases and asked about remaining penetration opportunities, particularly in other arrhythmias like SVT or VT, and what product/data is needed for expansion.

Dr. Stein confirmed the 70% AF penetration but noted 30% remains. He identified atrial tachycardias (atypical atrial flutter) and ventricular tachycardia (VT) as prime expansion areas for PFA. He mentioned ongoing studies for VT ablation using FARAPULSE technology and highlighted that future catheters like FARAPOINT and FARAFLEX (in development) are designed to excel in these areas.

“We are already engaged in a couple of studies of using FARAPULSE technology for ablation in the ventricles, and it's one of the areas where both FARAPOINT catheter and FARAFLEX catheter, which is in development now, and we're very pleased with the progress of that in its first human use studies. But that is one of the areas where, again, I think those catheters and those form factors are going to shine.”

asked by Christopher Pasquale · answered by Ken Stein