iRhythm Technologies (IRTC) Q4 2024 earnings summary

Executive summary

• Achieved Q4 2024 revenue of $164.3 million, up 24% year-over-year, and full-year revenue of $591.8 million, up 20.1%, with accelerating volume growth and record new account openings in long-term monitoring and mobile cardiac telemetry.

• Expanded commercial reach with over 30% penetration in the U.S. ambulatory cardiac monitoring market, over 70% share in LTCM, and more than 50% of large IDNs with at least one primary care physician prescribing Zio.

• Advanced international expansion with launches in Austria, Netherlands, Switzerland, Spain, early commercialization in the UK, and regulatory approval in Japan.

• Recognized for innovation and operational excellence, including awards, successful product launches, and manufacturing automation initiatives.

• Maintained regulatory compliance as a top priority, progressing on FDA remediation and quality improvements.

Financial highlights

• Q4 2024 global net revenue reached $164.3 million, up from $132.5 million in Q4 2023, with gross margin improving to 70% in Q4 and 68.9% for the year.

• Adjusted EBITDA for Q4 2024 was $19.3 million (11.7% margin), and full-year adjusted EBITDA was -$7.7 million, with a 520 basis point improvement year-over-year excluding IPR&D charges.

• Adjusted net income for Q4 2024 was $0.24 million ($0.01 per share), compared to an adjusted net loss of $25.8 million in Q4 2023.

• Ended Q4 with $535.6 million in unrestricted cash, cash equivalents, and short-term investments, generating positive cash flow for three consecutive quarters.

• Full-year adjusted operating expenses were $511.3 million, with Q4 adjusted operating expenses at $116.7 million.

Outlook and guidance

• 2025 revenue guidance set at $675–$685 million, representing 14–16% growth, driven by sustained U.S. volume growth and international expansion, with about 1% of growth from international markets.

• Adjusted EBITDA margin for 2025 expected at 7–8% of revenue, with Q1 2025 margin negative low- to mid-single digits.

• Gross margin anticipated to remain flat in 2025, with operational improvements offset by 50–75 basis points of potential tariff headwinds and an 8% Medicare price decline for Zio AT.

• Expects to be slightly free cash flow negative in 2025, turning positive in 2026.

• Focus remains on expanding U.S. market, accelerating international growth, and advancing product innovation.