iRhythm Holdings, Inc.

Hello, everyone.

Thank you for joining us, and welcome to the iRhythm Holdings, Inc. Q2 2026 Earnings Conference Call. After today's prepared remarks, we will host a question and answer session. If you would like to ask a question, please press star 1 to raise your hand. To withdraw your question, press star 1 again. I will now hand the conference over to Lisa Pecora, Senior Vice President, Finance and Investor Relations. Lisa, please go ahead.

Thank you, operator, and thank you all for joining iRhythm's second quarter 2026 earnings call. With me today are Quentin Blackford, iRhythm's President and Chief Executive Officer, and Dan Wilson, our Chief Financial Officer. Thank you for joining us. are not limited to statements regarding our intentions, beliefs, and expectations about future events, strategy, competition, products, operating plans, and performance. Forward-looking statements on this call are based on current estimates and assumptions, involve risks and uncertainties, and actual results may differ materially. These statements are made as of today, August 6, 2026, and are time sensitive. Thank you for listening. Additionally, during the call, we will discuss certain financial measures that have not been prepared in accordance with GAAP. Unless otherwise noted, all references to financial measures on this call are presented on a non-GAAP basis. These non-GAAP measures should not be considered in isolation or as a substitute for or superior to GAAP results. Reconciliations to the most directly comparable GAAP measures can be found in our earnings release and the slides accompanying today's call. And with that, I'll turn the call over to Quentin.

Good afternoon, everyone, and thank you for joining us. Dan will then talk about our financial performance and guidance in more detail. Second quarter revenue was $224.2 million, up 20.1% year over year. This marks our seventh consecutive quarter of growth above 20%, a meaningful accomplishment and a reflection of the durability of demand for Zio, the strength of our commercial execution, and breadth of our growth drivers. Momentum remains strong across cardiology, primary care, innovative channels, and international markets. We are particularly pleased to see that growth translate into exceptional margin expansion, demonstrating both the strength of our platform and the operating leverage inherent in our model. The combination of sustained top-line performance and increasing operating leverage gives us continued confidence in our strategy and the substantial opportunity ahead. Let me turn to our agreement to acquire Vital Connect, which we announced today. Vital Connect for some time and developed a great deal of respect for its technology, its people, and the platform the team has built. We are enthusiastic about bringing our organizations together because the combination meaningfully expands the ways we serve physicians, health systems, and patients, while remaining closely aligned with our mission to improve diagnosis, prevent disease, and ultimately enhance patient care. Vital Connect brings a complementary and comprehensive platform that supports four cardiac monitoring modalities, mobile cardiac telemetry, or MCT, event monitoring, long-term continuous monitoring, and short-term Holter. Its technology is also FDA-cleared for continuous patient monitoring in the hospital, further expanding our capabilities beyond ambulatory cardiac monitoring and across the continuum of care. The strategic fit is compelling. Vital Connect reinforces our commitment to innovation in ambulatory cardiac monitoring and adds an FDA-cleared platform with a patient monitoring service up to 30 days, 4-in-1 device functionality, flexible service models, live looking capabilities, and multivital monitoring. These features complement our existing portfolio and give us additional tools to meet different clinical, operational, and economic needs of customers and patients. This acquisition also expands our ability to participate in the MCT segment. This is a large market segment, and customer needs vary considerably by workflow, site of care, and patient population. Adding Vital Connect's proven platform to our national sales force will give physicians and health systems on a nationwide basis greater choice and flexibility. Together with ZOAT and ZOMCT, the acquisition of Vital Connect creates a complementary set of solutions to serve different MCT customers and patients. VitalConnect is also important to the broader evolution of our platform. Its biosensor can monitor up to 11 physiological parameters, including ECG, heart rate, respiratory rate, and body temperature, providing a robust foundation for our multivital strategy. Over time, these capabilities allow us to address a wider range of clinical needs and care settings, including inpatient monitoring and hospital-to-home programs, creating additional avenues for sustainable long-term growth. Financially, we expect the transaction to strengthen our long-term growth profile. We anticipate a positive contribution to revenue growth beginning in 2027 and thereafter. Combining VitalConnect's business with the meaningful progress we continue to make in our base business, we remain confident in the combined company achieving our previously communicated adjusted EBITDA margin target of 15% next year. Thank you for joining us. Thank you for joining us. Turning to another central element of our strategy, reaching patients earlier in their care journey. We believe that at least 27 million people in the U.S. are at risk for arrhythmias, and many of these individuals first engage with the healthcare system through primary care, value-based care, and population health settings. This creates a significant opportunity to expand access to Xeo by embedding long-duration cardiac monitoring more directly into the clinical workflows where patients are first identified, evaluated, and referred. During the quarter, we advanced our predictive arrhythmia solution strategy with the signing of two commercial agreements through our partnership with Lucem that combine predictive identification workflows with iRhythm monitoring solutions. These partnerships are intended to support earlier diagnosis and intervention, and our pipeline of additional opportunities continues to develop. We are also expanding our predictive arrhythmia solutions work with Desert Oasis Healthcare, using AI-driven analytics to identify patients who may benefit from cardiac evaluation and monitoring. We continue to see strong momentum in the innovative channels, which was our fastest growing channel in the quarter. Demand remains robust across a growing network of value-based care, primary care, and population health partners. As these programs scale, utilization is expanding in both symptomatic and asymptomatic patient populations. Early pilot programs have demonstrated more than 85% accuracy in identifying patients with clinically relevant arrhythmias before they enter the diagnostic process. Thank you for joining us. The goal is straightforward. Increase awareness of symptoms and risk factors. Help patients seek evaluation sooner and make the connection between primary care and cardiology more efficient. Thank you for joining us. Thank you for joining us. In the Netherlands, we are deepening relationships with key opinion leaders as we position the business for future market expansion. And in Japan, the higher reimbursement rate we discussed last quarter became effective on June 1. In each of these markets, we are staying disciplined in how we execute, investing to generate clinical evidence, advance reimbursement, and build scalable commercial capabilities. Globally, we also continue to expand the body of evidence supporting the clinical and economic value of our platform. Data presented at the European Heart Rhythm Association, the American Diabetes Association, and the International Society for Pharma Economics and Outcomes Research add to our body of clinical evidence on outcomes and economic benefits of early detection and disease management with long-term continuous monitoring. Turning to adjacent markets, sleep remains a large and underpenetrated opportunity with approximately 40 million sleep apnea patients in the U.S., many of whom overlap with arrhythmia populations. Thank you for joining us. First, a positive development during the period on reimbursement were the final LCDs issued by Meridian, CGS, and Palmetto, which addressed key areas of ambiguity in the initial drafts and delivered a constructive outcome. Importantly, these LCDs clarify appropriate modality-specific coverage without introducing additional access restrictions. Overall, the final policy removes a source of uncertainty for the market. Second, we achieved an important milestone this quarter with FDA clearance of our third generation algorithm, which will be used across our entire platform. Once launched in the first half of 2027, we expected to reduce clinical technician review time by as much as 50%, driving meaningful productivity gains and approximately $100 million of cumulative cost savings over five years while supporting continued margin expansion. We're also excited by the incremental opportunity to leverage this capability on the Vital Connect platform over time. This is a strong example of how our investments in data and AI can improve both the customer experience and the efficiency of our operating model. Third, as you know, we remain subject to an FDA warning letter and continue to work through the agency's review process. We have updated the agency on the completion of our remediation activities and our self-initiated third-party audit and look forward to their return in anticipation of closing out the warning letter. Thank you for joining us. Finally, I'd like to provide a brief update on the recent cybersecurity incident we announced in June. On June 8th, we identified unauthorized activity in certain third-party hosted business applications. We promptly activated our response plan, engaging external experts and notifying law enforcement. The incident has been contained and the root cause identified. While certain data was exfiltrated, our investigation and remediation actions resulted in no material impacts to our products, patient care, business operations, or financial results. Looking forward, our priorities are clear. Sustain volume-led growth across cardiology, primary care, and innovative channels. Continuing to improve profitability through scale, productivity, and disciplined execution. Advancing key innovation initiatives, including next-generation MCT and predictive AI. Thoughtfully expanding into international and adjacent market opportunities. And maintaining the strong operational and compliance foundation that supports long-term success in a rapidly evolving landscape. With that, I'll turn the call over to Dan.

Thank you, Quentin. We delivered another quarter of strong financial performance supported by sustained demand for our ambulatory cardiac monitoring services and continued operational discipline across the business. We generated robust year-over-year revenue growth while delivering record profitability, demonstrating our ability to scale efficiently and translate growth into significant operating leverage. We remain encouraged by the momentum across the business and the consistency of our execution. Revenue for the second quarter was $224.2 million, up 20.1% year over year, reflecting healthy demand across our customer base and continued momentum in newer growth channels. Volume remained the primary driver of growth, complemented by modest pricing gains and continued strong execution in collections. Thank you for joining us. This sustainable improvement was driven by targeted operational efficiencies, including manufacturing automation and workflow optimization, as well as product mix and scale benefits from higher volumes. Second quarter 2026 adjusted operating expenses were $145 million compared to $145.2 million in the prior year period, a decrease of 0.1%. Our expense performance also reflects a focused approach to investment as we funded key growth initiatives while thoughtfully managing costs across the broader organization. As a result, we kept operating expenses essentially flat while delivering strong revenue growth and operating leverage. On the bottom line, gap net loss for the second quarter was $0.4 million or net loss per diluted share of $0.01 compared to a gap net loss of $14.2 million or net loss per diluted share of $0.44 in the second quarter of 2025. Adjusted net income for the second quarter was $19.3 million, or net income per diluted share of $0.58, compared to an adjusted net loss of $10.2 million, or net loss per diluted share of $0.32 in the second quarter of 2025. These results highlight the progress we've made in building a more profitable business, as operating leverage across the organization contributed to significant year-over-year improvement in earnings. Adjusted EBITDA for the second quarter was 43.3 million, or 19.3% of revenue, representing an improvement of more than 1,000 basis points compared to the prior year. The year-over-year improvement reflects our disciplined spend management, moderating FDA remediation expenses, and timing of innovation and growth-related investments. Thank you for joining us. We ended the quarter with $591.3 million in cash, cash equivalents, and marketable securities, a strong cash position that provides us with substantial flexibility to fund future growth initiatives. Before turning to our guidance for the remainder of this year, I wanted to give a few comments on the financial aspects of the Vital Connect transaction. We expect the acquisition to positively contribute to revenue growth beginning in 2027 and thereafter. with Vital Connect currently at an approximately $65 million annual revenue run rate. For gross margin, we expect that the combined company will remain above 70% gross margin by leveraging the scale, operational infrastructure, and AI capabilities we have built. And finally, as previously noted, we remain confident in the combined company achieving our previously communicated adjusted EBITDA margin of 15% in 2027. We look forward to providing more detailed guidance following the closing of the transaction. This outlook reflects sustained demand across our core business while maintaining the same disciplined approach to forecasting newer and emerging channels. On a full year basis, we now expect a modest positive contribution from pricing relative to 2025, attributable to the price benefit we realized in the first half, with revenue growth continuing to be driven primarily by volume growth across XeoMonitor, Innovative Channel, XeoAT, and International. In the third quarter of 2026, we anticipate revenue to be in the range of $221 million to $223 million, consistent with typical revenue seasonality. For gross margin, we remain confident in our ability to sustain the strong margin performance we've delivered year to date, while continuing to drive meaningful improvement relative to 2025. The efficiencies we've created across clinical operations and manufacturing, combined with increasing scale and the adoption of AI-driven workflow tools, support further reductions in our cost to serve over time. With respect to the broader macro and geopolitical environment, we've taken proactive steps to manage potential cost pressures and do not currently expect a material impact on our gross margin outlook. Based on our performance year to date and outlook for the remainder of 2026, we are raising our full year adjusted EBITDA margin guidance to 13% to 14%. This reflects the benefits of continued scale, disciplined expense management, and a balanced investment approach across our key growth initiatives. We anticipate certain investments and growth initiatives, including targeted investments in primary care expansion, to ramp in the second half of the year. For the third quarter, we expect adjusted EBITDA margin of 12% to 13%. Excluding certain unique items, such as litigation settlement payments and transaction costs, we continue to expect free cash flow to increase year-over-year in 2026, with stronger cash generation in the back half of the year, driven by the normal operating cadence of the business. Before closing, I'd like to briefly address the preliminary physician fee schedule proposed by the Centers for Medicare and Medicaid Services, or CMS. We view the proposed reimbursement rates up low single digits across both long-term continuous monitoring and mobile cardiac telemetry as further validation of the healthcare industry's continued focus on earlier disease detection, preventative care, and evidence-based clinical decision-making. These trends align closely with Zio's strengths in delivering objective diagnostic insights through extended uninterrupted cardiac monitoring. We look forward to reviewing the final rule, which is expected later this year, and will provide additional commentary at that time. In closing, our second quarter results reflect the strength of our execution and the increasing profitability of our business model. Moving forward, we remain focused on expanding patient access, operating efficiently, and investing thoughtfully in the opportunities that position us for long-term success. With the addition of Vital Connect, we look forward to delivering profitable growth where we will continue to balance profitability expansion with disciplined investments towards growth. I will now turn the call back to Quentin for closing remarks.

Thank you, Dan. This was an excellent quarter for iRhythm. We are encouraged by the momentum in our business and the opportunities we see to further expand our impact. We delivered our seventh consecutive quarter of revenue growth above 20%, expanded margins significantly, generated strong free cash flow, and raised our full-year outlook. Our results reflect the strength of the Zio platform, the consistency of our execution, and most importantly, the work of our people. At the same time, today's agreement to acquire Vital Connect represents an important next step in the evolution of iRhythm. It adds complementary monitoring capabilities, expands our presence in MCT, and provides a foundation for multivital monitoring and additional care settings that will meaningfully benefit patients and customers over time. We are enthusiastic about the strategic potential of the combination, but we will remain disciplined in how we integrate the business, prioritize investments, and pursue the opportunities ahead. Our strategy is clear – expand access, advance innovation, and execute with discipline. Before we move to Q&A, I want to thank the entire iRhythm team. Over the past month, Newsweek recognized iRhythm as both one of America's greatest workplaces and one of the world's greenest companies. Those recognitions belong to our employees. Their talent, dedication and commitment to our mission are what make our performance possible. And our culture remains one of the most important competitive advantages we have. With that, we're now happy to take your questions.

We will now begin the question and answer session. Please limit yourself to one question. If you would like to ask a question, please press star 1 to raise your hand. To withdraw your question, press star 1 again. We ask that you pick up your handset when asking a question to allow for optimum sound quality. If you are muted locally, please remember to unmute your device. Please stand by while we compile the Q&A roster. Your first question comes from the line of John Young with Canaccord. John, your line is open. Please go ahead.

Great, thanks. Congratulations on the strong quarter and congratulations on the BioConnect acquisition. I know it's a high-quality company that we've known for several years. Could you walk through the synergies you expect with the MCT business specifically? How will you position their existing MCT offering versus upcoming DO MCT? How do you expect this will accelerate the MCT category overall for iRhythm? Thanks.

Yeah, thanks, John. Appreciate that question. Look, we've followed Vital Connect for quite some time at this point and understand their technology really well. And I think we understand the MCT category really well. as well. I think what we've come to realize is that there's going to have to be multiple product offerings in that category to ultimately succeed. And so we remain committed to AT, to MCT, and now the Vital Patch. If you look at it, you know, ZOAT for us was a product that could really serve about 50% of that MCT market, just given the short duration, 14 days, not being able to get out to 30 days, not having the live-looking capability, the downgradable, you know, four-in-one capability. Those were all things that were sort of shortcomings with AT, yet it still served a good part of the market. Vital Patch opens up the remaining 50% of that market. Even our own ZOMCT product would only open up probably another 20% to 30%. So having Vital Patch in there gives us access to the entire market, which is probably a billion-dollar market growing in the high single digits. It's a probably incremental $500 million market opportunity for us. So we're excited with it. We're excited to get this through HSR review. We expect that to close by the end of the year, and our focus is going to be integrating this into the commercial team in the very first part of next year.

Your next question comes from the line of Joanne Wunsch with Citi. Your line is open. Please go ahead.

Good afternoon. This is Anthony on for Joanne. Thanks for taking our question. This was a pretty impressive quarter on EBITDA margins, keeping OPEX essentially flat. Any reason not to maybe raise EBITDA a bit more? And then also just a quick follow-up, was there any tariff refund benefit this quarter? Thank you.

Yeah, thanks, Anthony. Appreciate the question. Maybe hitting the second part of your question there first, no, there was not a A tariff benefit realized in the quarter, so that was not part of the 19% adjusted EBITDA margin that we delivered in the quarter. You heard in my prepared remarks, you know, there are some investments that we intend to make in the back part of the year. We are raising, you know, full year adjusted EBITDA guidance and are ready to deliver, you know, call it over 400 basis points of improvement versus 2025. We're really excited about that leverage that's coming through in the business. At the same time, we see a lot of opportunities ahead of us to continue to grow the business and talked about primary care, continuing to open that up, innovative channel, sleep, other other initiatives like that. So we always want to be thoughtful and drive towards profitable growth and really balance those investments in the business to drive growth, but also Your next question comes from the line of Alan Gong with JP Morgan. Your line is open. Please go ahead. Hi, thanks for the quarter and congrats on the good quarter and deal.

I guess I want to dive a little bit deeper into a question that was just asked. I understand that VitalConnect helps expand the remaining 50% of the market, but arguably it could also handle the 50% of the market that is currently addressed with AT. And with VitalConnect, a big value of the technology is the additional markets that it seems to open. I think we've talked to them, they've valued the transition care and patient monitoring hospital at home as markets in the billions of dollars as well. So, I guess just again on the positioning, should we think of this as more of a new product to target those opportunities and unlock the remaining 20 to 30%? And then when we think about technologies that you've talked about, maybe being a stepping stone into other modalities like sleep apnea, is this the deal that we should have been looking for?

Hey, Alan. Thanks for the question. You know, and I think you go back to my prepared remarks. We certainly hit on those exciting new opportunities that come via the Vital Connect transaction. They are exciting to us, and honestly, they're part of sort of the roadmap that we've been focused on for some time now. And hospital monitoring is certainly interesting to us. They've done a nice job of entering into that space already and beginning to make inroads there. The hospital-to-home segment is something that We've talked about in the past, particularly as we build out our own multivital product capability, now VitalConnect accelerates that capability, having multivital capabilities already on their platform. So those are nice synergies in the transaction and very synergistic relative to the overall strategy of our company. I wouldn't leave out RPM as well. Real patient monitoring is another area of focus that they've built out a capability very nicely around. That's something that we've also had on our roadmap as well. So this certainly goes well beyond just the MCT market. It absolutely opens up incremental opportunity within MCT. And I think we're going to be able to benefit patients and customers meaningfully more as a result of it. But MCT alone is not the only reason that we're interested and excited about Vital Connect. So you hit the nail on the head with respect to those incremental ancillary market opportunities that I do think can be valued in the billions of Your next question comes from the line of Marie Thibault of U.S. Bancorp BTIG. Your line is open. Please go ahead.

Hi, thanks for taking the question. I just wanted to quick check in on the direct-to-patient marketing that you've started, I think, in some select zip codes. Can you give us an early read on what you're learning from those efforts, and should we expect that you'll plan to expand that program here in the quarters to come? Thanks for taking the question.

You certainly, Marie, should expect that we're going to continue to lean into and expand it, and that's part of the incremental spend in the back part of the year that Dan was alluding to. We know that direct-to-patient Director of Consumer, Primary Care. These are all areas that have real potential behind them and early indicators are that they are real opportunities. So we will continue to invest in those. They'll be measured as we go to make sure that we're seeing the sort of returns that we expect to around them before we just lean into them even harder. But we're excited by those. We are in the very early stages of the initial DTP efforts and the in-clinic, in-position office marketing that we're doing with patients. It's a little bit early to measure those results, but I will tell you that the confidence is high enough right now that we're going to continue to lean into it and excited by what we're going to see out of it. So we're a little early, but we're excited by it.

Your next question comes from the line of Stephanie Algazi with B of A. Your line is open. Please go ahead.

Hi, thanks for taking the question and congrats on a good quarter in the deal. I just wanted to check on ZOMCT and how that's tracking relative to previous expectations for the launch in the first half of next year and anything, any progress you would share on the mobile gateway data submission to the FDA. Thank you.

Yeah, thanks Stephanie. So we continue to make progress on ZOMCT. It continues to be A priority for us and an area that our teams are focused on. As you'll note, you know, in my prepared remarks, I commented on the fact that we remain focused on getting clearance on that product in the first half of next year. I think it's important for you to realize, though, that we expect Vital Connect will close before the end of the year, which means we are going to be focused on integrating that Vital patch into our commercial team's hands right around the turn of the year, the very early part of next year, which requires training and launching across a nationwide platform. So that will be our number one focus as we enter into this deal and transaction and look to close it here in the near term. At the same time, we're going to continue to focus on the submission of MCT and getting that clearance so that we do have optionality as we go into the future. But I think it's important for folks to realize Vital Connect is the primary focus here in the near term as we look to launch a new product into the MCT space, which will be that Vital patch.

Your next question comes from the line of David Saxon with Needham. Your line is open. Please go ahead.

Great. Good afternoon, Quentin and Dan. Thanks for taking my questions, and I'll echo the congrats on the quarter and the deal. So yeah, I just have a multi-parter on the Vital Connect deal. So you talked in the script, $65 million run rate. I think that reflects a slowdown they saw in the first quarter due to a transition. and my understanding is they recovered from that and are kind of ramping and targeting about 100 million next year. So is that a fair way to think about, you know, what they could do from a revenue contribution perspective in 27? And then the second part of the question is just, I mean, my math, you know, you're the leader in the extended Holter category, obviously. You'll probably get a couple points there from their platform. And I mean, I would guess your MCT share is going to have a two handle in front of it. So just, you know, talk about your confidence in getting it through kind of the, you know, regulators and whatnot. Thanks so much.

Yeah, there's a lot in there and I'll ask Dan to jump in and help if I miss on anything or just remind me of what we've missed because I want to try to hit all of it for you. I'll come back to, you know, this is a company that we've spent a lot of time getting to know over the years and certainly have really come to appreciate their technology and frankly the teams behind the company that have been building it. But there have been some structural considerations over the years that made it very difficult to step in and acquire the company. And we've had those conversations with the teams over the years, and Peter and that team did a nice job of addressing those right towards the end of last year and into the beginning of this year, which did create a little bit of a hiccup in that business. They've come out of it really nicely. They're growing quite nicely now and we're excited by what we're seeing in that business. So they have addressed that and I see that as temporal and the recent business trends would certainly indicate that was the case as well. But having addressed that particular issue now opened up the opportunity together with nice gross margin improvements that we were seeing in that business to step in and acquire the company. And so we're excited to be at the point now to be able to do that. In terms of run rate revenue, what that looks like for next year, we're not going to get out and guide to 2027 at this point in time. Some of that's going to be contingent upon exactly when the deal does close. We're going to wait until that happens to give you sort of a forward look and a guidance of the combined companies. Again, our idea is that this thing will close by the end of the year, but until it does close, we're going to hold back on providing combined company guidance. At the last point on HSR Review, or getting through the FTC. This is very much about the MCT product category. It's a very competitive transaction. I mean, there's a tremendous amount of competition that remains in the MCT category. The largest players in this space really focus in MCT between BioTel and Preventus and others. And I think that the combination of our company and and Vital Connect doesn't change that competitive dynamic within the MCT category. So we're excited by the opportunity, feel very good about the ability to get through the FTC and the HSR review, and we'll keep you updated on how we progress through that.

David, I'll just add on the revenue. I can't necessarily speak to what they've quoted historically, the $65 million run rate that I had in my prepared remarks. That does contemplate our revenue accounting. Your next question comes from the line of Nathan Trebek with Wells Fargo. Your line is open. Please go ahead. Great. Good evening. Congrats on a strong quarter and on the deal.

Quentin, are you seeing any sign that the very strong growth you've seen in innovative channels is beginning to normalize, or do you still believe those channels are still in early innings? And then if you could just talk about the cadence of new partner ads in the quarter, and I guess what's implied in the second half relative to the first half.

Yeah, we continue to be excited with the innovative channel opportunity, and I just think you whether it's primary care, whether it's value-based care, population health, there's so many different angles in that innovative channel business that has us excited and the teams continue to add new partners as we go. We saw another healthy quarter of new partners coming on board. I think that the reality is they all come on board at different paces and in different ways and that gets a little bit hard to forecast and predict and so we've not changed our way of thinking about how we look at innovative channels into the back half of the year and in our guidance it's more of a wait and see approach with That business, but it has been encouraging. It continued to grow incredibly well in the second quarter. You know, it was exciting to see our very first employer-sponsored plan sign up within the Innovative Channel business. I continue to think that, you know, employer-sponsored plans remains a meaningful opportunity in these self-insured populations. So I'm excited to see that door begin to open. I just, I think we're still in the very early innings here and we'll continue to lean into it, focus on it. But we're also going to be measured in how we think about it in our guidance, and we'll let those results play through before we get ahead of ourselves.

Your next question comes from the line of Vijay Kumar of Evercore ISI. Your line is open. Please go ahead.

Hi, guys. Thank you for taking my question. Quentin, I want to go back on the EL. I just want to make sure we understand the old rationale. Is it This feels like a dual product strategy, right, with an MCT. And I know you have a 2.0 product that's going to address the other part of the market. So it just feels like, is this going to be cannibalistic? Like, how is Vital Connect going to fit in? Does this reduce your enthusiasm for 2.0? I know there's been some questions about delays on 2.0 submission to the FDA. Has it been submitted to the FDA? and I think on the stock issuance, do we know the number of shares that are expected to be issued to fund the deal?

I'll let Dan hit on the stock issuance piece. It very much is a dual product strategy within the MCT category.

Back to my prior comments, I think it's going to take multiple products to really serve that MCT category as effectively as possible.

There are just so many different preferences when it comes to physician needs and expectations in that category, patient needs and expectations. There's some that like the longer wear duration that can get out to what will be 21 days in our MCT product as a single wearable patch. There's others that don't mind replacing a patch every seven days or so and getting out to 30 days of monitoring is more important to them. Sometimes the downgradable aspect is more important to physicians or to patients or having the live look-in as they're wearing the device, being able to peek in and see what's going on. Those are all different requirements that our customers, physicians, and patients ultimately have in this category. So I do think a dual product strategy is the right one. You mentioned ZOMCT 2.0. I think maybe you're referring to MCT 1.0, which is what we're working to get clearance with the FDA. That continues to progress, and we continue to seek that. but there ultimately would have been a pathway in our own product roadmap that would have taken MCT 1.0 onto MCT 2.0 that would have introduced many of the features that you're seeing in the vital patch as well. So now we've accelerated that into our product portfolio and frankly we'll have multiple product offerings to serve this segment sooner than what we had ever anticipated in the organic roadmap pathway that we had.

And BJ, on your question on number of shares issued, just as a reminder, $50 million in equity and calculated with a 30-day volume-weighted average price. That equates to just a little more than 420,000 shares, which is less than 1.5% dilution.

Your next question comes from the line of David Rescott with Baird. Your line is open. Please go ahead.

Oh, great. Thanks for taking the question and congrats on the quarter and the deal. I wanted to ask a two parter on the deal itself. I totally appreciate the MCP angle, but you called out some of these multi parameter sensing and many more. and many more. additional opportunities to break into multi-parameter monitoring, you know, could come about. And then when you think about the, you know, either cost synergies or investments that you've made that Vital Connect has made, you know, is there anything in particular that you can call out there when you think about more of the cost energy side of it? Thank you.

Sure. So let me hit on the first one and then Dan can take the second part of that. When you think about the multi-vital opportunity or the incremental sensing parameters that are out there, there is some overlap in what Vital Connect has already been able to achieve on their vital patch, along with what we were looking to do in our own efforts internally. So it does speed us up in terms of bringing some of those incremental sensing capabilities onto an iRhythm platform or a combination of iRhythm and Vital Connect's platform now. But there are also some incremental capabilities that we were focused on and that we acquired through that IP license with Biointellisense. And those are important. As an example, we really like the PPG capability that Biointellisense has. We find it to be very differentiated, unique. Like our freedom to operate in and around that, you would ultimately see that come together in our platform, including the vital patch. Those are important and complementary to each other as we think about the future. They don't obsolete each other. They just help build an even stronger product into the future that we think can serve many more patients, obviously open up new markets. I think multivital monitoring is going to be very important in the whole hospital into the home segment. It's going to be important with RPM capabilities. These are all new markets that aren't contributing to our We're excited by it. There's still work to be done, to be honest with you, on the whole product roadmap. You'll hear more from us into the future, but early thoughts around it are exciting.

David, on the second part of your question there, I will say growth really is the primary focus of the of the acquisition. We see a real opportunity there to leverage the commercial engine that we've built and the reach that we have there, the clinical service capabilities we've built, and I'm excited about seeing that come to life as we bring VitalConnect into the combined company. On the cost side, I would say we've built kind of operational capabilities and scale That we really believe will allow the two companies to operate more efficiently than than they would kind of independently, much like our core business. Our focus is on profitable growth as we think about this deal. So a lot to leverage there in terms of the capabilities that we've built. And if you think about it, you know, they're really call it kind of 10 years, 10 years behind us in terms of the build out of of capabilities and operational infrastructure. and that's exactly what we're going to bring to bear as we welcome them to iRhythm.

Your next question comes from the line of Mike Pollark with Wolf Research. Your line is open. Please go ahead.

Hey, this is Juran from Mike. Thanks for taking the question. I think if I heard correctly, you mentioned that new stores contributed 45% to volume growth, which is down from previous quarters. So maybe what's driving that decel and how should we think about that in the cadence in the coming quarters? Thanks.

Yeah, I appreciate the question there. We have commented previously that that number can kind of fluctuate and vary quarter to quarter. You have heard us speak to a number of the large accounts that we opened up in 2025. And if you recall, that was in the early part of of 2025. So those accounts and in addition to those a few innovative channel partners kind of rotated out of new store into same stores as we define it there. And so we saw that flip a little bit to the same store side. I would say importantly, still seeing solid growth from both sides of the business and would likely expect that to stay a little more weighted towards same store given the dynamics that I just mentioned.

Your next question comes from the line of Richard Newiter of Truist Securities. Your line is open. Please go ahead.

Hi. Thanks for taking the questions, guys. Great quarter. Congrats on the deal. I actually have two questions on the deal. I'll ask them both from the front. First one is what exactly is The top priority or the biggest thing you need to do or entailed in integrating Vital into your infrastructure. And is there anything that's kind of, you know, you got to get this right or this is kind of the heaviest list. So if you just answer that and where the biggest kind of focus is there. And then the second question is, you mentioned earlier, you said heading into 27, you know vital is your key priority and it sounds like you were talking about that relative to zomct i just want to clarify if that's the case because and in any way is this a signal that you're de-prioritizing zero mct in favor of vital thank you thanks richard uh so let me hit the first one um you know in terms of what needs to happen to make sure this is successful right out of the gate i think there's there's really two things that

I'm most focused on and will be driving as an organization in the team. One is introducing the Vital Patch across the nationwide commercial team, increasing access of this product for patients and physicians alike across the entire country. This is a company that began, grew, scaled sort of in the northeast, north central, the southeast, taking it from call it 30 reps under there Control to a commercial force of 200 plus on our side. We're going to make sure that that goes off well, that we're trained up well, and that our customers have a great experience with this as it makes its way into the market. Along with that, from an operational perspective, that means we need to be able to scale the volumes quite quickly to support what we think will come with a nationwide launch. And so think about that from an inventory, supply chain, distribution, logistics, intake capability Those are all things that we're very much focused on and we'll be spending time really ensuring that we're able to meet that demand as the two companies come together. With respect to prioritization and MCT, it's important to realize we are continuing our efforts on MCT. We're not backing away from MCT. I do believe that you need a multi-product strategy in this MCT category to ultimately be able to go after the entire marketplace. ZOMCT will be a superior product to ZOAT. And over time, we need to move away from ZOAT and onto the ZOMCT platform. We know it has a better cost profile. There's more automation that we can put to it in our manufacturing centers. It has a longer wear profile. These are all very important things to us. And so I think if you go back to my prepared remarks, you see our focus is on continuing to be on getting that product cleared with the FDA. ensuring we have optionality in that MCT product space or market space. However, just given where we think that we're going to close with Vital Connect, we're going to be in a situation where that product is going to be available to our commercial team ahead of clearance with MCT, or at least that's our belief because we think that we'll get through the FTC by the end of the year. That means we need to be prepared for an integration of Vital Patch onto our commercial force as quickly as possible. So I'm just trying to lay out for you sort of how When we think about things coming together, I think Vital Patch and Vital Connect, you know, gets closed earlier and we're not going to wait around for an MCT clearance to then, you know, figure out do you introduce one product versus the other. We're going to lean right into Vital Patch, get that out there and get going with it.

Your next question comes from the line of Suraj Kalia with Oppenheimer. Your line is open. Please go ahead.

Hi, Quentin. Can you hear me all right?

We got you.

Perfect. Gentlemen, congrats on the quarter. So, Quentin, forgive me, many calls going on at the same time, so I must have probably missed this. Is the value proposition for VitalConnect really about the VitalConnect NCT product? And partly the question, within the question is, you know, the algorithm is going to be different for VitalConnect versus the ZOMCT product. Even if we're going to keep the bridge devices and everything aside for now, I'm just talking about the software component. So maybe if you can help us understand that if the logic here to keep, you know, to push VitalConnect initially until ZO-NCT comes online, I'm just trying to understand the need for VitalConnect at this time, especially on the NCT side. And apologies again if you've already talked about that.

Yeah, well, I think Vital Connect brings, and the Vital Patch in particular, brings incremental features beyond ZOMCT that are very interesting to us and are important to be able to compete in the entire MCT category. Again, the four-in-one capability, the live-looking capability, getting out to 30 days, as an example, opens up a remaining part of the market that ZOMCT can't get to. That's a meaningful market opportunity. That's another $200 to $300 million market opportunity that, frankly, VU MCT just could never have gotten to. So back to my point of needing to have various products and feature sets, I think that's very important to be able to compete in the entire MCT category. So yes, we do like what Vital Patch brings to us within MCT, and I do the MCT product, or sorry, the MCT market. I do think, you know, it opens up incremental opportunity on our own ZOMCT product. But beyond that, it also opens up things like inpatient monitoring, in-hospital monitoring that they have clearance for. It opens up opportunities like hospital into the home, RPM capabilities. Those are all unique capabilities of their product and their platform that we're excited about and believe open up new revenue opportunities into the future. Your final. I'm sorry, but you had one last point on the software algorithms. Look, we're going to be able to bring the best of both companies together in this respect. We've done a good amount of work around the clinical side of it. We feel good about their product. Obviously, we as iRhythm have invested tremendously over the years in clinical data. We'll continue to do that in the future on the combined platform and I think leverage our learnings and put the best products into the market.

Thank you. Your final question comes from the line of Mason Carrico with Stevens, Inc. Your line is open. Please go ahead.

Hey, guys. Thanks for fitting me in here. A lot's been asked, but I guess I think you guys have mentioned the potential for a publication or some data later this year showcasing real-world economics within the Innovative Partner Channel. Is that still on track? What other initiatives are you deploying to help potentially accelerate these partners moving from pilot to more enterprise-wide deployment?

That's a great question, and you're exactly right. We commented on that. In the past, we do continue to expect to see some of that real-world data make its way into the marketplace in the back half of this year. We expect one of our innovative channel partners to continue to work to publish information. We've had Your next question comes from the line of Brandon Vasquez with William Blair.

Your line is open. Please go ahead.

Hey, everyone. Thanks for the question and congrats on the quarter and on the deal. I'll just leave it to one question, maybe a big picture question. As you bring in kind of this complementary technology from Vital Connect, do you think as you look down in the future, you know, sleep or maybe even we've had discussions in the past about diagnosing valve disease, etc., Does this expedite or make a clear line of pathway to some of the future TAM expansion opportunities? And if so, you know, does that look like a commingling of the two products, maybe on the back end at least? Or does the hardware eventually merge? Do you always keep two pathways? Just talk a little bit about that, what this deal might look like in three to five years instead of just in the next couple of years. Thanks.

Yeah, it's a great question, and that's part of what really excites us about the opportunity. When you start to look out three, four, or five years, you think about the new markets that are starting to come into reality at that point in time, whether it is you're in hospital, you know, monitoring in the med-surg, you know, ward within the hospitals, as an example. You can start to see the whole hospital into the home, monitoring, really trying to bend the cost curve of readmission back into the hospital. I think we're going to be able to monitor all the appropriate modalities off of this sensor that are important. And importantly, we have an IDTF capability in the background that is providing monitoring for a lot of these health systems that just don't have the capacity to do it. And so I love the way we're positioned to be able to get after some of those new market opportunities out into the future. I do think other disease states are going to continue to grow and become more prevalent. You've heard us talk about sleep. Sleep continues to be important to us. We'll continue to lean into it. I like what we're learning there. It's going to be a real opportunity for us. Heart Failure is another one that I think has a real opportunity to be impacted. And I think the combination of our two companies gives us a platform with a lot of flexibility on it where we can take the best from both sides over time and really improve what is available to patients and physicians in the marketplace. So a lot yet to come, but there's a lot of capabilities on our own platform that I think would be terrific on There are no further questions at this time. I will now turn the call back to Quentin for closing remarks. Well, in closing, I'd like to take an opportunity to recognize our employees on a terrific quarter, in many respects, a record quarter across so many measures for us. And it's really their commitment and execution that has made this possible for the company. We continue to deliver strong results while continuing to invest in the opportunities that are going to drive the growth of the company into the future. And with a differentiated market position, expanding capabilities, the strategic addition of Vital Connect, We believe we're well positioned to extend our leadership and create long-term value. So as we celebrate our 20th anniversary, I couldn't be more proud of the team, more optimistic of the future, and I thank all of you guys for joining us today. See you soon.

This concludes today's call. Thank you for attending. You may now disconnect.