Acarix AB (publ) (ACARIX) Earnings Call Transcript & Summary

[Foreign Language] So hello, and welcome again to Acarix [indiscernible], and we are very delighted to welcome the CEO, Helen Ljungdahl Round; and CFO, Christian Lindholm here today to give us a presentation of the Q2 and a business update. Welcome.

Thank you so much, Don. And good morning, and welcome to everyone who's joining us for our Q2 earnings call here for Acarix. I'm here, as Don said, together with Christian Lindholm, and the way we're going to divide up the presentation today is that I will go through highlights of accomplishments in Q2, but also looking a little bit of a half year that we've just gone through and with an outlook to the rest of the year. Christian will, of course, go through the numbers in more detail. You have the full report. It was issued this morning. And then after the presentation, we're more than happy to take questions. So you can send them in with a link that has been provided. What I want to say is that we're in a very exciting phase in the company right now. We're building up our commercialization, we're strengthening that with especially our focus on the U.S. market. And we're starting to see some real momentum, and this is what I want to talk about today and how important that is. And we also have to recognize that entering into a market like the U.S. takes a lot of focus and a lot of attention and a structured approach. And we are seeing traction now, but we also should keep in mind that it will take time before we really get to see things really moving. So we're a publicly traded company here in Stockholm. So of course, I will share the disclaimer. There might be some of you that are not so familiar with the company. So I would like to just take a couple of minutes here in the beginning. To give you an overview. So Acarix is a Swedish medical device company, but we were born out of academia in Denmark, [ but are ] Scandinavian. We're focusing on solution in cardiac diagnostics, and we're focusing on a significant medical need in the market. And this has to do with chest pain. And it's estimated that about 1 million patients seek attention for chest pain every day around the world. And we have a very interesting solution that we would like to provide and try to solve and effect -- make it more effective to manage these patients. Our CADScor system that you see on the screen here consists of essentially 2 components. There's an acoustic part and there's an AI part. And the acoustic part is really unique in its ability to listen to the blood flow in the coronary arteries. And you have to imagine this, these coronary arteries are around the heart, and we can listen to the blood flow inside the arteries. If it's healthy, there is a very smooth sound. And if there's plaque buildup, which is an indication of coronary artery disease, the sound changes. And the microphone here on the chest will pick that up and then process it into the body of the device. And then on the device, there will be a score. A score under 20 indicates that the person has a low risk of coronary artery disease and can be ruled out. And we can do that with a very high degree of certainty, 96.2%. If the result will be over 20, it doesn't mean that the person has coronary artery disease. It just means at that moment in time, the CADScor system could not rule out that individual. But the active listening part takes about 3 minutes. And in total, I would say, about 10 minutes. And that's quite different from other types of diagnostics, which [indiscernible] chest pain, such as stress test where you're on a treadmill that's an exercise. There's also others that are invasive. The other -- that has radiation associated with it. So this is a very nice point of care tool. As we entered the U.S. market last year, we started to have very interesting discussions with physicians around the country. And there was a general echo that the CADScor system should be a first-line diagnostic aid, which is a really unique positioning. So used early when the patient comes in and then provide immediate results and ultimately be able to rule out patients and lessen the burden on healthcare systems, both in terms of resources but also in terms of costs. We have a very impressive clinical program behind the CADScor system, and we have a fantastic R&D team, multiple -- thousands of patients in clinical studies. And to date, we have about 29,000 patients that have been tested with the CADScor system. We have a solid patent platform that we're on, 45 patents. And the clinical program behind the product has actually generated regulatory approvals in Europe with the CE marking. And then also the FDA DeNovo Clearance, which means that there is no other technology on the market that is with any similarity to the CADScor system. What's unique about the U.S. and why we really stepped up our efforts there is that we have a CPT III code. So the American Medical Association has given us a reimbursement code that was linked also to support from the American College of Cardiology. So full ramp-up on the U.S. market. Now let's look at -- take a little bit step back again. What is it? Why are we doing this? And we've thought a lot about this. But with the product that we have, because it's a new product, it has a unique potential. And we see that we have the opportunity to transform early cardiac diagnostics for chest pain patients. And what I would like you to remember about this mission is that the CADScor System, first of all, it's accessible. It it's not a big machine, a big capital investment. It's easy to install in any clinic. It's easy to use. It provides a rapid answer and it's accurate. So with that mindset, we are pushing as hard as we can to make an impact for patients with chest pain, initially around the U.S., but also longer term in other markets. So Q2, I would say that in 2022, we started building a subsidiary in the U.S., and we had to put some building blocks. You've heard me talk about that in place. But some of that is now starting to pay off. And I think what's most exciting in Q2 was that we started moving through the Veterans Administration faster than we had expected. And I actually have a couple of slides on this because I would like to go a little bit deeper into this achievement and what we can expect seeing going forward. We also, in Q2 here in May, released what we call the clinical workflow. So when we came into the U.S. we had the idea that the CADScor System should be used early. It's one thing for us to talk about that, but we need an organization behind us that could validate that. So we -- and as many of you know, we signed a collaboration agreement with ACC. We work together on this clinical framework, clinical workflow. And that actually went faster also than we had expected, and we released it here in May. That workflow is laying the foundation to a lot of clinics in terms of an IDNs, how they use it. And what's exciting, and I'll talk more about this, is that the VA, when it came out in May, said, we are going to adopt this with a small tweaks, but we're going to incorporate it. And this is how the CADScor System should be used. Our footprint, coming into the U.S., I don't want to talk too much here because I'm going into these in a little bit more detail, but we have rapidly expanded, during the first part of this year, going from 13 states coverage in December and now in July, we just reached 50 states. So we're now fully covered in the U.S. So that's a big bold move in terms of getting that coverage across the country. Patches, our business model is based on selling systems and patches. And the patches is where on the long term, we're going to be, first of all, really profitable, but also generating ongoing revenue. And what we keep a close eye on is the patch per day use. And it's interesting to see, and both I will talk a little bit about it, but especially Christian, on what we're seeing coming into the U.S. It's significantly higher patches per day than we've seen in Europe earlier. Reimbursement is something that we continue to work on. There's nothing significant to report here other than that we are consistently starting to see payments. Sometimes it requires an appeal, but the payments do come in the end -- this -- in Q2, we saw some payments as high as $600, which we haven't seen before. So some insurance companies are now starting to pay out more to the clinics than what we've seen earlier. Our sales in the U.S., and I'm focusing on the U.S. here is -- did increase in Q2 versus prior year. And if we look at the full half year, we increased with 200% compared to prior year. And this, of course, will continue to increase. Our gross margin, we have a guidance that by 2024, we should be at 80% gross margin. The last 2 quarters, we've been tracking above. And in this quarter, we are 84%. And then also in Q2, we had some financing rounds, direct issues and warrants that came in and financing is something that any company that are in our face, accelerating growth needs to pay attention to. So we work very closely with the Board on that. Let me spend a little bit of time on the VA because this, as we see it now, is increasing in importance for us in the U.S. market. The Veterans Health Administration is the largest healthcare network in the U.S., and it serves military and veterans. There's about 9 million patients that they take care of. Their goal is to provide very good care and also to bring innovation sooner into the VA. President Biden signed a 2023 budget at the end of last year, and that was a 22% increase compared to prior year. And if we look at the numbers, they're kind of daunting but $119 billion is spent on health care. So the way the VA works is that they have hospitals around the country. There's about 170, 171 hospitals. And then there are primary care clinics or outpatient care clinics that are associated with that. So sometimes there's maybe a 2, 3-hour drive to the hospital and then the patients are seen in the outpatient clinics. But in total, that's about 1,300 locations around the country. We started talking to the VA last summer. That was our initial discussions. And it was -- became quite clear very early that the CADScor System meets a very specific need. Cardiovascular disease is very common. Chest pain is very common. Often, it can be anxiety as well. So it's important to determine, is it related to the heart or not? And many veterans for obvious physical reasons cannot do stress test, et cetera. And it might be a long way to go for CT. So there was a very nice match early, and we had our first order in Q1, and that was for 11 systems in Southeast Louisiana associated with a box per system. And we haven't seen the repeat orders yet, but I'm going to explain why. But that was an important order. One is that we're selling into the U.S. government. So the U.S. government has looked at us, they've done their due diligence, and we are now an approved supplier to the U.S. government. It also gives us credibility and recognition around the country. So if a clinic is asking us who's using this, if we then mention that the VA is using the CADScor System, it gives it the credibility stamp. It also gives validation to the CADScor System. They've done their due diligence. They see that this is a first-line diagnostic aid so it gives us that credibility, but it also importantly, one location open stores to others. So then let's look at what have we done since that first order in February. And this is a question I get quite often. When the order was made, the next step for us was to train that location. And as we were training, they said, this is a great technology. We need to clearly define within the VA in that location, how the CADScor System should be used. So they started -- and they do this. They make protocols for all types of illnesses and accidents or whatever it is that comes into the hospital and how they should be managed. And they decided we need to do one for the CADScor system. They started working on it and then multiple departments involved. And in May, when the ACC workflow became available, we shared it with them, and they said this is exactly what we need. And they made some tweaks to it, but it gives a lot of credibility also to what the ACC working group did together with us. So that workflow was essentially accepted and I'll cover that in a minute. And they started taking this through for approval. Now anything that's going into a big institution like that needs multiple signatures. So in Q2, it was about securing the protocol, the standard operating procedure and then securing the signatures. At the same time, a close by VA in Mississippi was looking at what Louisiana was doing and said we want to order systems. So we had a second order from the VA already in June then. And we've expanded our sales team here in Q2, so we doubled the interactions that we were having with the VA. So now if you look at this map, this is a VA map on how the different regions are divided and we have representation now across all regions, and we're having discussions with different VA locations around the country. So coming into Q3, and I just want to share where we are year-to-date, this week, we announced that finally now, the SOP in Southeast Louisiana was approved. All signatures are in place. That is now a protocol for routine use of the CADScor System within that location. What's interesting is that the other VAs are also saying, we want to adopt the CADScor System, but now somebody has already prepared the standard operating procedure. So just 2 days ago, our sales reps after the press release went out, they are being trained on how to talk to additional VAs about this. I guess we could call it a protocol or a standard operating procedure so that we can now accelerate around the country. So certainly, in Q3, we're expecting additional orders from additional VA locations, but what's really exciting is that we now have ticked all the boxes to become eligible for a VA national contract. And I had a plan for when we needed to start this by and we have already had because we have various locations, and we have a protocol to link to that. So that's super exciting. When you look at the VA, I think the VA in itself almost can help us reach our revenue target for 2024. It's potentially a very big customer it's the government. So sometimes it works slow. But in our case, it's proving to move very quickly. So we are spending a lot of time on this, and we have dedicated resources to work with the VA. Just a few words, I'm going to shift gear a little bit to the clinical workflow. This was released in May and it -- what it says essentially, and this is very much in line with what the VA has accepted now, is that patients that come with chest pain, the physician will do a history, physical exam and an EKG and then they do a CADScor System. And if the score is below 20, they are ruled out. If it's about 20, they continue and evaluate them as they would have. The only exclusion is somebody who is over 70 years old with multiple risk factors, the chance of getting a score of 20 is very low. But the work we did with American College here in the fall has really laid the foundation for how we move so fast with the VA. And now we are discussing this workflow, of course, with IDNs and clinics, et cetera. And there's a very, very positive response. Coming into the U.S., it could be extremely expensive. The country is huge. And I just want to put this in a little bit of perspective because when we reached the end of 2021. Christian and I had put together put in place a subsidiary in the U.S. We were able to hire. We were able to take orders, but we had no coverage. So starting in January and February, it was about recruiting and starting building a management team. At this time, I went to Denmark, I picked up my CADScor Score system took it in through the airport. So in that -- in Q1, there was essentially 1 unit in that came in with me. But we had no sales representatives. And then we started hiring sales representatives in May, and we started to have discussions and doing our due diligence on commission-based sales agents. So we were building up our coverage. And the way we did this was really moving through the prevalence of chest pain. But we were at 30 states in December coming in with CompleMed, which is a great organization with highly experienced cardiology train sales represent that they who also know the U.S. Healthcare System. We went to 43 states in May. And as I mentioned, in July, now we're at 50 states. So now we're starting to think about how we're going to regionalize the country. But remember, flying from New York to San Francisco is almost the same as going from New York to London, three time zones. So it makes sense to start to break it up into regions. But in Q1 and Q2, we sold to the VA, and we are ahead of plan with IDNs, we're on plan and hospitals were on plan where we've seen a slight delay is in clinics because of reimbursement. So that is something that we continue to work on and making sure that they are getting paid because that's a condition for them to continue using the CADScor System. So on the reimbursement, and I've shared this slide before, there's nothing significantly different to report. We are tracking at about $160 per assessment. And then we have seen now recently payments as high as $600, which is very attractive for clinicians. But we are seeing an increase in the number of claims that are going in. We don't see everything, of course, but the ones that we track, we're seeing increases. So what does the business case look like? It's really interesting, actually. And if we take this -- this is a high volume, so a clinic using 100 patches per month at the end of 3 years, with an average reimbursement of 160, our calculations has been that the clinic would make about $284,000 in a 3-year period. Acarix will make about the same because of our -- we have a very high gross margin. But what's interesting, I was just with a high user a couple of weeks ago, and he was sharing with me that even in the first 6 months of using the CADScor System, he's also already reaching about 1/3 of that within 6 months. So depending on the volume and depending on what they're getting paid, this is a very good business case. So it is a win-win, both for the clinic and for Acarix. But it's not just about the money stream here. It's also a quick response to patients. It's a solution to offload a high volume of patients and then also for patients to avoid unnecessary testing. So a few words about the management team. I mentioned that we started recruiting in the U.S. Our first appointment was in March last year. And Jennifer Matson from Medical Affairs was one of the first to be hired. But we built out this team now, and we have 5 of us based in the U.S. In Sweden, we have Christian, who will speak to just in a couple of minutes here. He's the CFO and he's based in Malmo. And then we have Thomas and Claus that are based in -- outside of Copenhagen, and they manage all of our R&D activities and operations. And I hope that soon, we're going to be able to tell you more about what's happening in those spaces as well because we're certainly making progress there as well. Mike is new to the team, and Mike is the leader of CompleMed and CompleMed is a medical device distributor, but with deep knowledge of sales in cardiovascular and also into the U.S. Healthcare System. So with Mike and the team coming in creating one sales team under the leadership of Mike, we now have a very solid team to drive adoption of the CADScor System. Mike himself has over 33 years, and I know some of you have looked and Googled and tried to find information about Mike. So that's why I'm taking a minute to share this. But he has more than 33 years of experience in cardiology and industry and also the health sector. He actually managed electrophysiology departments across one large IDN and then has transitioned into the MedTech industry as Head of Sales and Commercial. So it's great to have him on the board. This week, we also press released and we're very happy about this, that Dr. Deepak Talreja is coming on board to be a medical adviser to us. And when we came into the U.S. market, we did not have clinical studies. We did not have clinical experience, but we're generating a lot of interest now. And Dr. Talreja has a very solid background. He's also been at Vanderbilt University, but fellowship at the Mayo Clinic. His interest is really in preventive medicine or preventive cardiology. And as we've had these discussions, he sees a really interesting use of the CADScor System. He is currently practicing. He's the Director of Cardiovascular service line at Sentara Healthcare Network, which is covering Virginia and the northern part of North Carolina. And there's about 12 hospitals in this IDN. But he becomes Chief of Cardiology here in the beginning of next year. So very excited about this, and we're looking forward to be working with him. And I would actually like instead of me explaining, we saw him a couple of weeks ago and asked him to make a short video for us. So I would like to share that with you, it's here.

Cardiologist with Sentara Cardiology Specialists in Hampton Roads, Virginia. I'm based out of Virginia Beach in Norfolk and I'm with Sentara Cardiology. We're a large practice. We cover a total of 12 hospitals and 13 outpatient practices. I serve on the faculty of the Eastern Virginia Medical School, where I've been in practice for the last 19 years. since I graduated from interventional cardiology training at the Mayo Clinic in Rochester, Minnesota. In a busy clinical practice, we're trying to bring to each patient's care, the best available information and technology to diagnose problems like unrealized coronary artery disease. The hardest group is that patients who we know has risk factors, maybe a family history for high cholesterol, hypertension, diabetes, dyslipidemia, but they haven't had any imaging that gives us an answer necessarily as to whether they have plaque not. But certainly, many of those patients, I can order CIMT scores or coronary calcium scores. That, of course, will be done in a separate setting in the hospital, and then I'll have to react to that later. This is where a test like the CADScor System really shines because it's easily done in the office. It's inexpensive. It has no exposure to radiation or real other risks, and it can be 1 piece of the puzzle of figuring out what's going on with this patient, what's their risk. And so I find it to be a really useful technique in that group of patients that I want an answer for them what's going on and I want to assess their overall risk and come up with for that primary prevention or secondary prevention patients, what's the risk level -- do I have to worry? Do I need to do additional testing? Or can I give them reassurance. And I get a quick answer right there that we can integrate into that first discussion with the patient. I'm often asked what helps me as a clinician develop comfort with the CADScor System. Over the years, I've tracked the data on the initial early trials, which have been published in the peer review literature showing the benefits of this and risk stratification of patients. Also as a member of the American College of Cardiology and the fellow of that organization with a particular interest in prevention, I've been following as Acarix has worked with the American College of Cardiology to develop a proposed workflow for using the CADScor System. My personal experience in using this in our office practice and seeing how that numerical risk stratification of patients can be added to my own clinical impressions to help get patients on the right track to prevention has really developed enthusiasm in needing for this product.

So it's very exciting to be so it's very exciting to be working so closely with Dr. Talreja. And right now, we are mapping a couple of projects, and there's more coming. And I'm really looking forward to share with you what we're going to be doing together. And of course, we're also in discussion with other potential medical advisers. So we want to build out a group of advisers that we can work closely with. But now we're going to shift gear a little bit and discuss the numbers in the greater details. With that, I'd like to introduce Christian Lindholm, our CFO, Christian.

Thank you, Helen. I will continue to discuss the past utilization in the company. It is our most important key metrics that we are following on a customer level. And it will also drive the company's growth and profitability moving forward. So what we can see on the U.S. market, we have a number of systems sold in the U.S. market. And what we can see already now is that the patch utilization is much higher than what we can see in the European market. We have a number of key customers. And the patch utilization at those key customers is around 3 patches a day. We also have 1 customer who is using 6 patches per day. So -- and that's very good. We could translate that to revenues at Acarix. So 3 patches a day is about SEK 500,000 on the top line. And as you know, the gross margin on the patches is very high. So more than 90% falls down on the gross margin or on the gross profit line in the P&L. Totally, we have sold about 29,000 patches on the European market and on the U.S. market. Looking into the rolling 12 months sales, we have -- we can see an increase with 21% from SEK 5. 2 million to SEK 6. 3 million in quarter 2, 2023. The increase is, of course, caused by the volume of patches and systems sold during the quarter. But also, we see the average pricing in the U.S. market much higher than if we compare with the European markets. It's also interesting to see the distribution of revenues quarter-by-quarter. If you look into quarter 1, quarter 2, 2022, we had just a small fraction from the U.S. market. That small fraction has gradually grown. And in quarter 1, quarter 2, 2022, U.S. sales represent about 50% of the total revenues in the company. On the other side, we have the European sales. And due to the transition to the U.S. market, the focus on the U.S. market, we expected and we can see that European revenue stream is decreasing some during this period. Looking into Quarter 3, revenues amounted to SEK 1.5 million compared to -- and yes, that's a decrease of 8% compared to the same quarter last year. I will come back to the reason why we see a decrease in this quarter. We totally sold 10 systems and almost 2,700 patches. And looking into the patches, it's a growth of about -- a little bit more than 40% compared to same period last year. As you can see, there's a big volatility between -- especially demand but also the quarters. And so it makes sense to look at first half year 2022, and compare that with first half year 2023, there we see an increase of 16%. The gross margin is high. We ended up 84% in quarter 2, '23, and that's an increase with 6% units from same quarter last year. And the reason why we see this increase is basically the sales that is increasing on the U.S. market. And also the increase in patch sales. And as Helen was mentioned, the profitability in the past sales is very high. If we look specifically on the U.S. market, quarter 2, we revenue recognized SEK 770,000 an increase of 30% compared to the same quarter last year. We sold 8 systems and 800 patches. And same here, if we look at the first half year '22, compare that with first half year '23, we have a growth of 200%. What we should know about quarter 2, when we do the math and comparing, we have a slowdown in sales and in April and May, we had an onboarding program running with the full sales team in the U.S., together with the training session and that, of course, decreased the customer visits, and that gave an effect, a negative effect on the sales. But now we have a fully, fully motivated sales team. We have a fantastic geographic footprint. We are covering 100% of the states in the U.S. And moving forward, later 2020 -- this year, and 2024, we expect sales to accelerate. My last slide is on the bottom line of our P&L, the EBIT and what we can see is that we have an EBIT of minus SEK 21.8 million in the quarter compared to SEK 18.4 million in same quarter last year. We have a -- we have the cost base and we have an increase in the cost during this period. And that's, of course, due to the buildup of the U.S. organization and the operation and also the investments we have done in order to secure the increased demand on the market now in late 2023 and especially 2024. So that was all from my side. So I will hand over to Helen. Thank you.

And as I mentioned early on in the introduction, you have the full report available, and we're happy to take any questions. I think it would be worthwhile to just take a minute to look at what is our focus going to be for the second half of the year. And of course, we are staying with this momentum now and focusing on the U.S. expansion. As Christian mentioned, we spent significant time here in May, training and getting the new team up and running so that they are effective out with customers. We are focusing on expanding the VA. We're starting the negotiations for a national contract, and we're going to move through that as quickly as we can. But this could be a long process. But in the meantime, we're going to continue to work with the different locations as we've planned. We also expect that this might be a bit bold, but that we will have our first sale to an IDN here in the back end of this year. The scientific leadership, the medical adviser part of our work is going to become increasingly important. And working with Dr. Talreja and other clinicians, we're going to expand that group. I have as a last point here, U.S. data and health economics. We do not have any U.S. data at this point. and we want to work with some of these clinics on collecting data so that we can start presenting what the impact of the CADScor System is in the U.S. Healthcare System. But it's an exciting next 6 months. I do want to mention, though, that we are still operating in the U.K. It's going well in the U.K. We are working in Germany. We're looking at other markets as they present themselves to us. But our focus is to deliver on the U.S. market. So that brings me to our guidance, and we reevaluate this regularly. We certainly do it at each quarter. And at this moment in time, we're not making changes. We're already tracking 2 quarters above the gross margin, we're looking at the revenue target. We know the prices are significantly higher in the U.S. So we are continuing with this guidance basing it on the performance in the U.S., and we are very much in line with the market trends that we see in the U.S. market. So that brings me to my summary slide before we go to questions. The key points to remember is that we are building in the U.S. for long-term success. We never had the intention to go in for quick wins. We want to win big. And that's why we're working in such a systematic way. We have a fantastic product. I still do not think we've had a single interaction where a clinician or a health care professional is not just intrigued by the CADScor System. So we're going to do everything we can with this great technology. And then the financials look really good. It looks like we're going to be able to build a very profitable company, and we have great team members that are working every day to make this happen. So with that, I would like to say thank you for your attention, and I think we're going to move over to questions. So Don, over to you. See if you have any questions, we'll come over here.

First, thank you for a very interesting presentation, seems to be a lot of things going on. And we have some questions from the viewers today but also some questions that have been sent in through e-mail previously to the company. But I would just want to start with a question on one, and that would be that you mentioned the clinical experience -- could you tell us a little bit more what does mean because I understood that the clinical programs were all completed.

Yes. So it's good that you bring this up, and I can clarify this. Our clinical development program, which was the basis for approval in Europe and in the U.S., they were done in Europe. So when you come to the U.S., the first thing they ask is where's your U.S. data. And we've been able so far with the FDA but also with clinician justify our data. But I do think it's going to come a point where we have to start to collect data in the U.S. And we now have people around the country who is asking to say, can I do an observation study? Can I follow and we start to maybe make some publications. So when we say start building data, we don't need data for regulatory approval. But many times in the U.S., physicians want to see how does it work in the U.S. population.

Okay. Thank you for the clarification. I will take the next question. We have some questions regarding sales on a more specific level. So we'll start with the broader level that was sent on e-mail and that is -- how does the sales team operates now when you expanded the geographical coverage so much?

Yes. So it's quite different to be on a sales call today. We have a regular teams meeting going from a few people on the screen to a full screen now. There's a much bigger team. But they have one leadership. We actually put everything under Mike with his experience. So they are working, whether they're a commission-based sales agent or an Acarix rep. They work together and they work in the same way. They work across our sales channels, and they know that we have to deliver short term, but we have to build for the long term. And sometimes we use the analogy of golf, where we -- to be good at golf, you got to do the short game and the long game. So they have that in their mind. So that's how they work. But the important point here is that it's one team. There's no difference whether you're a sales agent or representative, and they're pushing together in a very sort of exciting and energized way, I would say now.

And the more specific questions here from the viewers, it is first about CompleMed. And if they have made any sales yet and then from another viewer, we'll be able to see the sales from CompleMed already in the current quarter, the Q3? Or should we expect to wait 3 to 18 months from Q3 to see full impact?

So the CompleMed team is highly experienced and they know how the system works and they have a network. That being said, there is some weeks that have to pass for any position to make a decision. So they were trained. They really were out seeing customers on a grander scale at the end of June, beginning of July. So it does take some time. But we are working -- and I think we I see contracts coming in -- purchase contracts. So it's a matter of how quickly we can do it. But the winning factor here is being able to get short-term sales that are quicker with clinics and then the larger IDNs, so balancing that. How long is it going to take before we really see the impact it's really difficult to say because some things in this market is surprising us and going faster than we thought, some are going slower. So we readjust and they are also very nimble. But I would say we should see impact in Q3. We should see more in Q4 and even more in Q1 and then we're building towards our guidance.

And then it's another question also regarding partnerships here. So can you tell us how things are going with Bio-Rhythms, Strategic Health AK and Ancillary Care Services? Have they started selling? And when can one begin to see the full impact of these partnerships?

Well, Bio-Rhythm is the representative that helped us with the VA in Southeast Louisiana. And he is doing exceptionally well. Ancillary Care, they are covering different states. So Tennessee, Mississippi and Alabama. And those states are a little bit more conservative. But certainly, we have sold units, but they have been primarily to clinics but Bio-Rhythm is -- we're very happy with his performance.

And then do you still by the statements you previously made that the Q3 will be the quarter when the sales will start turning upwards?

It will turn upwards the magnitude of upwards. That's where I want to be cautious. But it will turn upwards.

And then I was thinking I will take an e-mail question, and that is what role -- what specific role will the medical adviser play for Acarix?

This is our first medical adviser. And the way that we see it is a very close collaboration. And he has very specific desires that he wants to work on with the CADScor System. But most important, I would say, is his -- he's a very experienced clinician, very well-known cardiologists, and we need to get the CADScor System into the U.S. Healthcare System, just like we did with the VA. Now we need to work on it with IDNs so I think he can help us advise us where the placement of the CADScor System should be in an IDN. So it's very much focused on the clinical use of the CADScor System and making that adoption go smoothly. But I also know that he has some interest in additional analysis, et cetera. So we'll try to accommodate both.

And how come the patch usage is so much higher in the U.S?

I don't know, Christian, do you want to take that?

I think we can -- there are 2 sides, I would say. It's the way that the CADScor fits into the clinical workflow. That's the clinical side and then we have the financial side clinics and hospitals, maybe not that much VAs, they are very focused. They are focused on the profitability. They need profitability in the clinics to make the clinic run it's often private owned and using the CADScor with a good reimbursement from the payers, from the insurance company as Helen showed, it's a good case financially for the clinics. We don't see that pattern on the Europe -- on the European market. So that's one factor. They can make money on the CADScor score. And then on the clinical side, maybe you can comment.

Yes. So in the U.S., heart disease is the #1 killer. It's extremely common. Chest pain is very common. [indiscernible] patients a year is estimated show up with chest pain. So these clinics, they -- some of them say 50, 60, 70 patients a day. And some of those are, of course, chest pain patients. So the patch utilization goes up because of the economics, but also because of the clinical need. And there's just such high patient volumes compared to what we've seen in the private market in Europe. But you have to remember, we don't have reimbursement in Europe. So we've been working on the private market, and they don't have those patient volumes, at least what that I know of.

And then we do have some questions here about the cash position. And yes, what statement is about that from the company?

We continuously look at our financing. We have to because of where we are with the company and we had some funding coming in here in the spring, and this is something that we look at with the board. And I have said before that we have different alternatives on the table that we consider and what we go forward to is ultimately a decision between the management and the Board. So that's about all I can say at this time that it's something that we're always keeping an eye on, of course. And then spending, we're keeping a very close eye on our spend levels and investing where we're going to get a good return.

Yes. And then we got a follow-up question regarding the medical adviser and that is currently engaged in negotiation with Sentara Health considering that their medical director has joined Acarix as the medical adviser.

Yes, it's important to separate these two. Our medical adviser agreement is with Dr. Talreja as an individual. Now he's very positive to the category system, and I see the discussions he's having with his colleagues. So we will see what happens there. But I think it's a fair assumption.

And then we had another question from the e-mail, and that was that you were in a very interesting pivotal point right now and how can we follow you best to get the updates?

Yes. So I would encourage you to follow us on LinkedIn, and now X as it's called. Then of course, we press release, but we don't press release everything we do. We're going to look forward to these quarterly reports, but my advice would be if you want to follow us, we have the website. We have LinkedIn, and we have X , and that's a good way to stay in touch. And then, of course, you can always reach out to Christian and myself with any specific questions.

If you want to be on the list for all the press releases, just drop an e-mail, and I will include you in the sendings.

Okay. Thank you very much. That was all of the question that is currently sent in through the live chats and also the e-mail. So thank you very much for the presentation and thank you to you all the viewers.

Thank you, Don. Thanks, Christian, and thank you for listening this morning. Thank you.