Boston Scientific again cuts 2026 guidance

Boston Scientific slashed its 2026 sales and earnings per share guidance for the second straight quarter as key businesses continue to face growth and competitive pressures.

CEO Mike Mahoney told investors Wednesday that the guidance cut is primarily due to struggles in two main areas: electrophysiology and Watchman. This is yet another quarter where the businesses have been challenged after historically being bright spots for the company.

“This update today is not the outcome we plan or what you have come to expect from us … However, market conditions have evolved quickly, and it’s been a challenge to forecast effectively,” Mahoney said.

Boston Scientific now expects 2026 net sales growth in a range of 5.5% to 6.5%, compared with previous guidance given in April for 7% to 8.5% growth. The company also knocked down its adjusted EPS outlook from a range of $3.34 to $3.41 to a range of $3.28 to $3.32.

In February, Boston Scientific forecast sales growth of 10.5% to 11.5% and EPS of $3.43 to $3.49.

Watchman, one of the areas Mahoney pointed to as dragging down Boston Scientific’s guidance, has traditionally been a strong growth driver for the company. Sales for the left atrial appendage closure device grew by nearly 30% in 2025, bringing in sales of $1.96 billion.

However, market dynamics are changing rapidly for the business. The Watchman unit grew by just 4.3% in the second quarter, bringing in $507 million.

Mahoney said the Watchman market has changed “dramatically” over the last six months. The company is seeing declines in standalone Watchman procedures, and while there has been growth in concomitant procedures, there are tougher comparisons to the prior year coming up.

Boston Scientific expects Watchman growth to be flat to low-single-digits for the full year, with the second half declining by mid- to high-single-digits. Mahoney said the company does not anticipate any improvements in standalone Watchman procedures in the second half of the year.

“We absolutely believe in this therapy and that Watchman is the best treatment for patients who can’t, won’t, or shouldn’t take oral anticoagulation for stroke prevention,” the CEO told investors. “We expect that the actions we are taking today will support the [left atrial appendage closure] market over time. However, we are not assuming Watchman growth in 2027 until we see the dynamics actually change.”

PFA share loss

Boston Scientific’s electrophysiology unit has similarly been challenged, particularly due to competitive and market pressures in pulsed field ablation. PFA, a new treatment for atrial fibrillation that has been one of the hottest markets in medtech over the past several years, once fueled Boston Scientific’s electrophysiology portfolio to triple-digit growth. However, increased competition from Medtronic, Johnson & Johnson and Abbott has eaten into that success.

“We did undercall the competitive pressures in the U.S. in terms of share taking,” Mahoney said. “We continue to be the PFA leader, but our share has come down.”

The treatment may also be coming up to a market growth ceiling in the U.S. Mahoney said PFA now accounts for 80% to 85% of ablation procedures in the U.S., which limits the company’s ability to offset competitive pressures.

Electrophysiology brought in $916 million in the second quarter, representing year-over-year growth of just over 9%. However, the quarter saw minimal growth when compared with the first quarter.

Amid the business challenges, Boston Scientific announced a global restructuring earlier this week that will result in layoffs. The company expects a total of about $700 million to $800 million in pre-tax charges from the reorganization. Mahoney told investors that the program, which is expected to begin this year and continue through 2029, should deliver approximately $500 million in run rate savings once it is complete.

While Boston Scientific’s electrophysiology and Watchman businesses are continuing to struggle, Mahoney pointed to the remaining three-quarters of the business, saying it is growing at about 6% year over year.