Boston Scientific Corporation (BSX) Earnings Call Transcript & Summary

Good morning, everyone. Happy to move to our next session on the second day of the JPMorgan conference. I'm Robbie Marcus, the medtech analyst here. And we have the Boston Scientific management team. CEO, Mike Mahoney's going to kick it off with a formal presentation, and then we're going to move into Q&A, along with Dr. Ian Meredith and Dan Brennan, the CFO. So just a few quick housekeeping items. Feel free to go to the JPMorgan health care website and get the slides for the presentation. Feel free to go ahead and put a question there. And then you could also e-mail me or get me on Bloomberg chat. And I can do my best to ask your questions. So with that, go ahead. And I will join you for Q&A.

Thank you very much, Robbie. We appreciate the opportunity, and thanks again for all of your interest. 2020 certainly offers challenges, but I'm very proud of how the BSC team responded and how we were able to serve our patients so well and also keeping our employees safe. We're extremely excited about the outlook in 2021 and beyond with continued growth from our category leadership positions, innovative pipeline, and execution, expansion in the higher-growth markets adjacent to our current call points, and continued solid progress in our margin expansion opportunity, along with enhanced digital capabilities. We're also well positioned to deploy a strong cash position and free cash flow for tuck-in M&A in 2021. So we believe we're well positioned for the recovery, given the strength of the diversified portfolio and our global team. Turning to safe harbor. Before I start, you'll -- safe harbor apply, and I'll be making forward-looking statements. And we encourage you to consult the risk factors of our latest SEC filings. And the regulatory disclaimers, here they are. And turning to Slide 4 on financial disclaimers. With respect to our financial disclaimers, please note that the financial highlights of this presentation include preliminary unaudited results for the fourth quarter of '20 and we'll provide audited fourth quarter '20 results during our fourth quarter earnings call, which is scheduled for February 3, 2021. The next slide really speaks to our mission and values, which is extremely important at Boston Scientific. Our global employees are unified and inspired by our aim to advance science to life. It's a blessing to work in this field, and we feel a deep responsibility and motivation to make a difference and pioneer new technologies to help physicians, patients and their families. Our core values are listed below in the bottom there. And importantly, we bring these values to life in our daily actions and use them to guide us in helping us making difficult decisions. Employee engagement is more important than ever, and we are pleased with the results in this area, recognizing there are always opportunities to improve. On Slide 6, you'll see a high-level summary of Boston Scientific sales mix in 2020. And I'll provide a more detailed view of our fourth quarter sales results in a few minutes. Over the past 7 years, we have focused on growing faster than our peers, while simultaneously diversifying our portfolio and our global sales mix into faster-growth markets. From an operating perspective, we run the various business units as global operating units. We enhance our global innovation across the company and productivity by leveraging technologies and capabilities across the business units and the regions. We also continue to see excellent growth in the emerging markets, where we have a long runway for growth in select markets that we focus on, including China, select markets in Latin America, Mid East, Africa, Russia and other select markets in Asia Pac. China continues to be the key growth driver for us in emerging markets, and we are very bullish on our China outlook. In China, we continue to scale the mix of our businesses, enhance our physician education, our digital capabilities and commercial footprint while also creating stronger R&D capabilities, which we've been working on for the past 5 or 6 years. On Slide 7, it's important to highlight the track record or performance that we've delivered pre 2020 and the COVID pandemic. So our historical performance demonstrates the consistent success we've had executing in this category leadership strategy and portfolio diversification strategy. It's important to reinforce that our multiyear financial track record pre-pandemic in 2020 was consistently growing faster than our peer group, up plus 7% organically, while delivering consistent operating margin improvement and consistent double-digit adjusted EPS growth. Notably, this consistent faster-than-market revenue growth pre-pandemic in 2020 was without any TAVR sales in the U.S. and pre the accretive-to-growth BTG interventional medicine acquisition. While 2020 was clearly a tough year, our procedural acuity, site of service and new product launches will aid our recovery. Post COVID impact, we continue to strive for above-market revenue growth and remain committed to driving operating margin expansion and double-digit EPS. Now I'll give you some more color on our fourth quarter sales and full year 2020. So overall, we're quite pleased with our Q4 2020 sales results this morning with a negative 8% organic decline in revenue. However, that included a 370 basis points of negative impact from WATCHMAN sales return reserves as we shifted to a consignment model as we've introduced WATCHMAN FLX quite successfully in the U.S. We entered the fourth quarter with a stated aim to return to growth, excluding the impact of WATCHMAN sales return reserves, as well as a caveat for the obvious uncertainty of COVID given its direction in the fourth quarter. Encouragingly, as the quarter went through, we actually delivered low single-digit growth in October. We're flat to down slightly in November and then sales declined in December as a result of the pandemic intensifying, particularly in the U.S. and in Europe. Our fourth quarter sales are largely consistent with our third quarter '20 results, which declined 6% on an organic basis, and that also included 230 basis point impact from WATCHMAN. So essentially, we grew negative 4% in the fourth quarter and negative 3% organically in the third quarter, excluding the impact of WATCHMAN. Encouragingly, Peripheral Interventions was our strongest-growth business in fourth quarter at plus 5%, led by 12% growth in the BTG interventional medicine business with EKOS growing in the high teens and TheraSphere up high single digits. The BTG acquisition continues to deliver on its strategic intent in creating clear category leadership in interventional cardiology while further strengthening our position in the high-growth venous market. In PI, our drug-eluting portfolio of Eluvia and Ranger continues to build momentum and grew high teens in fourth quarter '20 versus '19. And both our MedSurg segments, endo and neuro, also grew in the quarter at plus 1%. Neuro enjoyed double-digit growth in several of our key franchises, including LithoVue, SpaceOAR and Rezum. WATCHMAN really had a nice fourth quarter despite the impact of the pandemic. WATCHMAN is reported within our IC business unit, and it grew 18%, excluding the sales return reserves. The WATCHMAN FLX consignment conversion program was executed very well in the second half and is now essentially completed. Interventional Cardiology sales were impacted in the fourth quarter due to this WATCHMAN consignment impact as well as the conversion of our commercial selling model related to the DES tender in China. Excluding these fourth quarter events, organic sales growth for IC in the quarter was down 7%. Neuromodulation growth was softer as these products are in the lower end of the acuity scale comparatively versus the rest of our portfolio. So in the next slide, we'll highlight what to expect from Boston Scientific as we roll into 2021 -- or actually, in '21. The high acuity nature of our portfolio, multiple product launches, and a diminishing impact from the pandemic will all help Boston Scientific to execute well and significantly improve our performance in 2021. We will continue to execute our category leadership strategy and diversify the portfolio to high markets. And also the excellent work of our health care economics and reg teams in '20 led to multiple product approvals and reimbursement wins that position us very well going forward. Importantly, we leverage COVID to learn and accelerate our digital investments and capabilities in terms of customer engagement, education, marketing, procedural support, monitoring and service. We continue to live our core values with a very strong commitment to sustainable business practices and continue to be recognized externally for those efforts. And finally, given these elements, we seek to significantly improve performance and drive shareholder value, augmented by our strong balance sheet and capacity for capital deployment. And we continue to drive towards post-COVID financial goals for 6% to 8% organic revenue growth, margin expansion and strong cash flow as well as double-digit adjusted EPS growth. Now turning to Slide 10. We've shown this in years past, but we continue to update this, which is an important part of our strategy. This slide is key to understanding the Boston Scientific story as we've consistently position the sales mix of our company into faster-growing markets. So back in 2012, our slowest-growth markets represented nearly 50% of total company sales. In 2019, those markets, namely CRM and DES, represent 30% of our sales mix. And by next year, we estimate that mix to represent approximately 20%. This also has been driven by a focused investment in both internal R&D and acquisitions into faster-growth segments within endo, neuro, peripheral, interventional, oncology, structural heart, neuromodulation and EP. As a result of this work over many years, we believe that we now compete in a market basket that grows plus 5% post-COVID, and we aim to grow faster than the served market, consistent with prior years. We have summarized a few key growth drivers in each segment on the next 3 slides, which I'll move through quickly. On this slide, we highlight our MedSurg businesses, endo and our neuro public health. These businesses are extremely strong, and we believe these businesses will be accretive to overall BSC growth and margins throughout the LRP. We have very strong category leadership and leading market share positions in both of these business. And both continue to be a strong focus of our emerging market growth opportunity. In endo, we have a comprehensive leadership position in the 4 segments highlighted: Single-use scopes, pancreatic biliary, GI cancer and bleeding, and infection prevention. Just to highlight a few points here, single-use scopes, led by SpyGlass, EXALT-D and EXALT B, represent the single largest incremental market opportunity. And the EXALT-D launch was impacted by COVID, but we're poised to deliver strong growth in this category in 2021. AXIOS also continues to be a key growth driver in our pancreatic biliary segment. Turning to neuro. We've worked pretty hard over many years to earn a leadership position in the 3 segments highlighted: Stone, prostate health, and prosthetic urology. We look forward to launch of LithoVue Elite to strengthen our stone franchise. And prostate is our fastest-growing segment with new launches with SpaceOAR and increasing momentum from Rezum to treat BPH. On the next slide, we'll speak to our interventional -- our cardiovascular segments, which really represent Interventional Cardiology, led by [ Joe Fitzgerald, and Peripheral Interventions by Jeff Mirviss. I'll start off with WATCHMAN FLX, which continues to exceed our expectations. We had very strong results for the year and the fourth quarter. As I mentioned, despite the COVID headwinds, WATCHMAN grew 18% in fourth quarter once you normalize for the transition to consignment. We're pleased to have recently hit the milestone of 150,000 WATCHMAN patients treated and the recent approval and reimbursement of WATCHMAN FLX in Japan. We continue to enroll in indication expansion studies, such as OPTION and CHAMPION, as well as continue to drive market development and patient outreach in these highly underpenetrated patient populations. WATCHMAN FLX, the cornerstone of our structural heart franchise; which is rounded out by our next-generation ACURATE neo2 platform, which has recently launched in Europe; and Sentinel for stroke prevention, which we're doing multiple studies on. In mitral valve repair, we recently received FDA approval for our U.S. early feasibility study design and plan to get back in the clinic in the first half of 2021. Also, our Complex PCI portfolio continues to perform well, driven by our leading portfolio and physician training to treat calcium as well as our imaging portfolio. We have some nice launches in that category in '21. Turning to peripheral. In '21, PI has the strongest set of new product launches at Boston Scientific across the 3 segments. We expect PI to accretive to BSX growth and margins over this LRP period. Importantly, we're executing on our stated category leadership strategy across arterial, I/O and venous. These segments all represent high-growth markets and meaningful innovation opportunities. In arterial, we're excited about the Ranger launch in the U.S. and Japan and completing enrollment of SAVAL for BTK. We're also very bullish on BTG. Having grown 12% in the fourth quarter, we're ahead of our cost-synergy plan. Importantly, we're expanding the BTG Interventional business into the EU and Asia. Turning to rhythm and neuro. In CRM, we continue to maintain overall share in CRM and anticipate a similar result in 2021. We're quite pleased with the launch of our implantable cardiac monitor, and we're excited to be in clinicals for our leadless pacemaker in the first half of '21. Electrophysiology, we're expecting improved growth for this business in '21 on the heels of our expanding portfolio. We're particularly excited about the launch of POLARx in Europe and completing enrollment for this trial in the U.S. in '21. In addition, we're launching our force-sensing catheter STABLEPOINT in Europe in 2020. Turning to neuromodulation. This will be an exciting year in this business, and you'll see some product launches or information at upcoming NANS events. We're excited for the EU launch in 2020 U.S. launch of WaveWriter Alpha, which brings Bluetooth capability, MRI compatibility, multi-contact and dual wave platform technology for both primary cell and rechargeable, all into one platform. Vertiflex for lumbar spinal stenosis is another key driver as we help pain -- physicians address different types of patient pain needs. And our DBS franchise, Vercise, with its unique directional lead system, continues to take market share gains in the U.S. and Europe. And we're also encouraged by the positive early launch feedback of a new platform called Vercise Genus in Europe. Not all is lost in 2020. There were some learnings and new capabilities that we've latched on to and that we're reinvesting in '21 and beyond. We're quite encouraged and leveraged this change in the adoption curve in digital to increase our investments across a number of focus areas, including enhanced customer and patient engagement, medical education, clinical trial remote case support, sales force enablement and mobile solutions. We see these platforms as a key catalyst for growth and structural cost savings opportunities over time and continue to expand our footprint and these digital capabilities. I'll touch a bit more on our financial strength and flexibility in this slide. With our improved balance sheet, as we enter 2021, our #1 priority for capital deployment remains strategic tuck-in M&A that leverages our category leadership strategy. We'll also continue to be active with our venture capital portfolio, which has historically served us well as a nice pipeline for tuck-in M&A looking forward. In 2020, we generated strong free cash flow despite the pandemic, and we head into the year with minimal call side cash with approximately $1.9 billion in cash on hand, plus additional capacity through our revolver, while remaining focused on deleveraging and committed to investment-grade rating. And finally, as we did last month, we'll look to opportunistically deploy cash and the share repurchase as appropriate under our recently approved $1 billion authorization. In terms of our sustainability efforts, we want to bring this to your attention. Above all, at BSC, we're committed to acting with leadership and integrity in the communities we work and live in. We're dedicated to progressing business practices in areas important to our stakeholders, such as climate change, environmental impact, diversity and inclusion, community involvement, culture, talent, and innovation. We're making strong progress as reflected in some of the recent awards that are noted on this page. We remain focused on steady improvements. We'll publish our 2020 performance report this spring. So lastly, I'll wrap up with the -- what to expect from us, again, in 2021. I won't read through that slide again, if you wouldn't mind advancing that one. And I want to thank you very much for your time and your interest in the company. And we look forward to your questions in the breakout. Thank you.

Okay. Well, maybe we could start with the quarter here. It's the newest news here, and I want to spend a few minutes. It sounded like October was going pretty well when you gave the initial guidance commentary, even November was within the tolerance ranges. And then December was a tough month. And obviously, investors appreciate the past but are much more focused on the future. So maybe you could just walk through exactly what happened in December, where you saw the greatest impact. And do you expect that to continue into first quarter here as well?

Sure. Thanks, Robbie. That's a quick walk to the breakout room. Nicely done. Just as you said, October, we grew a little bit in October. Essentially flat to a slight decline in November, so almost kind of flattish through November. Then we had a softer December. Really, we attribute it primarily to the increasing COVID challenge that we've seen. The issues were -- we see that around the globe, but more focused in terms of impact in the U.S. and in Europe. Our Asia business held in there a little bit stronger, although you've seen some challenges in Japan, obviously, when you read the newspapers to see the TV results. So there was some impact there. You saw overall, some acceleration of growth in the quarter with a number of our businesses in endo and neuro, acceleration in PI, WATCHMAN delivered a stronger quarter. We saw some deceleration in our Neuromod business, where we called out in the script that you just had higher elective procedure mix in that business. And we saw a little bit of softening in CRM versus third quarter. But we still continue to believe that we maintain share in that category. So I'm sure we'll talk a lot about 2021. We do expect some COVID impact in the first quarter, clearly, given the market environment that we're in. But our businesses have shown strong resiliency. And essentially for the second half of 2020, we were kind of in that negative 3.5% organic range when you neutralize for WATCHMAN.

There were -- and through the script, there were a lot of positives. You talked about the BTG Interventional business up by, I think, 12%; WATCHMAN up 16%, ex the return reserves. So a lot of your key growth drivers that are going to carry the future are still even doing really well during COVID. It seems like -- if I could pull them out, it seems like the stent business was one of the weakest, Neuromod was one of the weakest, and probably some of the elective procedures within urology and endoscopy that suffered the most. I guess, what -- compiling a bunch of questions that investors sent in is, how confident are you that it's more market weakness rather than share loss? And does it vary by business?

We're highly confident, market weakness across most all of our businesses. You said endo and neuro doing pretty well. We don't consider 1% growth very good for endo and neuro. It's good in a COVID environment, I guess. But those businesses, along with PI, will be significant accretive to our overall Boston Scientific. So those businesses have very strong share positions, new launches that layer in. And so really, the softness, even though they grew slightly, is absolutely attributed to the pandemic. But we don't attribute that to share loss. There's pockets where we have some, maybe, share sensitivity and loss in pacemakers. And we haven't -- we've clearly lost share in EP. So I think from a share perspective, maybe those are 2 soft spots. But other than those 2, if you look across the entire Boston portfolio, it's either a hold or likely gained share. And really, the softness is all about the pandemic. And you saw back to some growth in October despite the pandemic. So as we look at '21, we expect some softness in Q1 with the pandemic. But as we all know, with the vaccines being rolled out, we think over the course of time, in '21, it will improve each month. And we see -- we're very optimistic for the business as we look into the second quarter and the second half as the pandemic impact reduces and these businesses get back to their normal market growth and our market share -- strong market share positions in them.

So The Street's sitting at 9% growth for first quarter off of 2% reported growth in 2020. It sounds, if I can interpret your comments, that Street probably has to come down for first quarter. Is that a fair comment?

Dan, do you want...

Yes. I don't think we'd specifically comment on a number. Our goal on February 3 on our earnings call is to give guidance, assuming that market visibility is conducive to that. But I think premature to comment on specific numbers until we discuss guidance at that point.

Got it. Maybe if I could come at it in another way. You had WATCHMAN growing 16% in the middle of COVID. I have to imagine there's some negative impact to that business. The BTG Interventional, 12%. Again, probably some impact from COVID there. So let's say, we're talking third, fourth quarter, '21, 2022, and hopefully, we're all vaccinated and we can put COVID in the rear-view and we get back to normal fundamental growth. Can we see -- maybe how confident are you that 6% to 8% is the right growth rate if we return to normal market growth? It's one of the top investor questions I get, why is it a 6% to 8% growth business? And how confident are you in that?

Yes. So the question, why is a 6% to 8% business ex COVID in a more normal environment? And I think it's just important to note that for 4 years in a row, pre-COVID, the company grew plus 7%. During that period, we didn't have any TAVR sales in the U.S. And since that time, we've added a very chunky smart acquisition with BTG, which has excess of $400 million of revenue in Interventional Medicine. And now we have more capacity for tuck-in M&A. And along with that, our exposure to our slower-growth markets has declined. And so I think from an investor standpoint, if you're looking out at '21 post-COVID, that's a strong backdrop. And then you add to those facts the enhanced product portfolio that we have. And we can go through each business, but our Peripheral Interventions business has a super-exciting setup for '21 with unique launches in arterial with Ranger; expanding our business in Interventional Oncology, and that likely be in the double-digit grower; and you saw venous grow high-teens growth in fourth quarter with our EKOS platform. And so I won't go through every single business, but it's really the acceleration, I would say, of our PI business, our endo business, our neuro business, very strong growth in WATCHMAN, and we have new platforms launching in Neuromod and DBS. And also the -- as mentioned, the WATCHMAN portfolio in complex coronary. So DES will continue to be a challenge. We're excited that we won the China tender because it positions our business in complex coronary to continue to grow in that business. It will be 2 -- 2x the size of our DES business in that country and [ 15% ] bigger than our DES business globally. So our ratio of our slower-growth businesses continue to get smaller and the portfolio is extremely strong, and you add on to that the emerging market growth and our balance sheet capacity for tuck-in M&A.

Great. I'm going to combine a couple of questions here. Getting a lot on WATCHMAN. How do we think about when the consignment impact ends? And how does that better position you against the potential launch of Amulet in 2021 in the U.S. market here?

Yes. So it ended. It ended when the ball dropped a couple of weeks ago. And so we go into '21 in a great spot with WATCHMAN. The consignment conversion has been completed. The demand from hospitals and doctors to use FLX exceeded our expectations, and we supported that with that strategic move. And extremely high percent of those accounts that use WATCHMAN, which is about 600 or so, have committed to long-term contracts with Boston at high share commitments with some price uplifts. So that program has gone extremely well. And despite COVID impact, you saw it grow -- what the growth? 18% in the...

18%, excluding reserve.

Another one coming in, getting several questions on Neuromod. That's one, I'm assuming, saw a pretty sharp drop-off in December. Any color you could give on cancellations versus trials? And are you seeing a difference in spinal cord stim growth? And if you could help us out with that versus Neuromod.

Yes. That's likely our most sensitive business in COVID. And so you saw a nice rebound, call it, in the fall, when there was the COVID impact seemed to be a little bit less for hospitals. But we saw quite a big impact in December with patients essentially deferring their procedure to later. So we expect -- we're bullish for our spinal cord simulation business throughout 2021, but it is likely the most sensitive business that we have related to deferability for patients. We're excited about new product launches that you're going to see at NANS. This exciting new algorithm called FAST, which we think is very differentiated, you'll learn more about that at NANS. So I think from a portfolio perspective, we're in very good shape there. And as COVID gets better, that business will get stronger, but is the most sensitive one. Our DBS business actually performed quite well in 2020 despite COVID. And that's business where we weren't a player 5 years ago, and now we're the #1 market share leader in Europe from a de novo standpoint and taking quite a bit of share from the competition in the U.S. with it. And also, we're -- there's an additional platform that's just launched in Europe in that area. So SCS will still be impacted going forward, but it will get better as COVID improves.

Fair to say that was down healthy double digits in the quarter?

Neuromod was down 12% in the quarter.

Okay. But it sounds like spinal cord stim was below that and DBS was above that. Is that fair? I see Susie saying, "Don't answer." So we'll move on. Let's move to one of the most exciting opportunities, I think, in 2021 is EXALT-D. It's basically you get a redo here on the 2020 launch. Help us set expectations. You have an NTAP which should certainly help make the sell a lot easier to hospitals and doctors. But just help us set up expectations for what EXALT-D could really do this year.

Yes. So we called out in the script, the whole single-use platform of SpyGlass, EXALT-D and EXALT B, all within the endo business, are very differentiator for that business in combination. And independently, they offer differentiation because the only ones that really have it. You mentioned EXALT-D. We're excited about the future of that. 2020 was tough for EXALT-D given COVID. The good news is during the year, physicians obviously realized the benefit of reducing the risk of infection, particularly in a COVID environment. We made great progress on reimbursement in the outpatient setting. And we're optimistic that we'll get strong -- potentially reimbursement in the inpatient setting over time here. So the health care economics are better than they were a year ago, clearly. We feel like we're significantly ahead of our competition in terms of our actual platform. The issue has really been access and driving that new workflow within hospitals. But we've placed quite a bit of capital as we enter 2021 and this will be -- we're not going to quantify it for you, but it will be a meaningful growth driver for Boston and within the endo business. Endo, neuro and PI will all grow quite accretive, we believe, to the overall BSC average, and EXALT-D will be a nice piece of that. And we talked about that being a multibillion-dollar market with those scopes in combination. And importantly, it's not a 2021 story. We have the ability -- these are 510(k) products. You'll see enhancements to EXALT-D likely every 9 months, just like we've done with SpyGlass. We'll continue to take cost out of the product, improve margins. And we'll hopefully launch EXALT B, the bronchoscope, by year-end in 2021.

Great. So I'm going to combine a couple of questions here from the audience. You just announced the sale of the BTG spec pharma business. I wanted people to realize that, that was probably a point of headwind to growth in the quarter by my math. So that will be great to get off of the P&L in 2021. It leaves you with the core interventional business. But the question is really, Dan, how do we think about where the proceeds for that are going to be placed? And if you can lump that into maybe the broader capital allocation strategy in '21 and beyond. You have a flush balance sheet, you raised capital earlier in the year. How do we think about your priorities for that?

Sure, Robbie. I think the great -- one of the great parts of the story heading into '21 and beyond is the strength of the balance sheet. I'd say it's the strongest it's been in many, many years, perhaps up to a decade. Relative to spec pharma, the way we looked at it internally was the $800 million proceeds for spec pharma, we, in essence, put those to use in Q4. We put $535 million to use to finalize our last open share repurchase authorization. So we exhausted that. And then we also took out $250 million of our April 2022 public bonds. So a nice balance there. So the $800 million, which the deal should close here in the first half of '21. But we kind of put that $800 million in our mind to use in Q4 rather than letting it sit. In terms of the overall cash position we have and our ability to deploy that, we're excited for '21. And Mike mentioned it, the 2 priorities are tuck-in M&A. It's out there. We have a long list of targets and do a lot of due diligence on that. So I'd look for something here in '21 on the smart, high-quality tuck-in M&A side. And then backing it up with opportunistic share repurchase on the other side of that. So from a financial flexibility standpoint, we're excited. I think it's a big part of the story going forward.

And Boston Scientific has one of the largest and most active venture portfolios. Is that something we should see more money going into? And should we expect anything to come out of that in 2021?

Yes. We have over 40 companies in there now, and it's obviously been a nice source of deals that we've done over the past few years. We'll continue to invest in new, high-growth, adjacent technologies in that portfolio. And over time, a few each year are going to come out and look to exit. And the beauty of having been in those companies for 3, 4, 5, 6 years, at some points, is you're a very educated potential buyer of those technologies. So I think a real nice leg of the stool of our ability to continue to fuel top line growth.

I want to get Dr. Meredith a question here. We had the unfortunate episode of LOTUS Edge coming off the market later in the fourth quarter. It doesn't appear to have hit WATCHMAN all that much in the structural heart portfolio. But maybe just give us an update on what you're hearing from the field both in Europe with the ACURATE neo2 launch and then in the U.S. with the structural heart portfolio with WATCHMAN?

Thanks, Robbie. I don't think it's really had a major impact on the launch of ACURATE neo2 in Europe. As you know, we've been very successful there. And the accounts that are -- actually [ have taken ] ACURATE neo2 have not been dissuaded by the results of Scope 1 and Scope 2, and the launch is going very well. And of course, it's allowed us to focus more closely on this technology. So I don't think there's been any specific or significant downside from the LOTUS Edge withdrawal with respect to the ACURATE neo2 as being utilized in Europe currently.

Great. And we're just about out of time. But Mike, I thought I'd leave you with some closing comments here, and I'll leave you with the question. What have you learned from 2020 that you can apply to 2021 and beyond for Boston Scientific?

Yes. Hey, 2020 was a challenging year for the company, but I'm extremely proud of the resiliency and the work of the team. We entered '20, not knowing COVID was going to hit us, with a multiyear momentum. We didn't have the best COVID portfolio, as you see in the results down, what, we're full year down 10% organic. But during the course of the year, we enhanced, I would say, our global collaboration, enhanced digital capabilities, we had a number of new products launched that will impact us in '21 and beyond and the team really pulled together. So the culture, the winning spirit of Boston Scientific is very strong. We know that COVID will get better and better in terms of its impact to Boston throughout '21. And we're poised to get back to our winning ways. And we look forward to proving any doubters that that's what we're going to do. And we have the portfolio and the leadership team to support that.

Well, great. I look forward to seeing you all in person in 2022 in San Francisco and hearing all the fantastic results. Until then, thanks for joining today, and have a wonderful rest of the conference.

All right. Thank you, Robbie. Appreciate it.

Thanks, everyone.