ABMD - pretty amazing survival data

I’ve taken a little break after earning season. A quick aside…Wow, ntnx’s stock price has really gone down the crapper! Good news though, ABMD released data from their post market tracking database.

-shows a relative increase of 24% in mean survival in acute myocardial infarction !!!

-Separately at TCT, Dr. O’Neill also presented initial data from the first 104 patients treated with the NCSI protocol. The data showed a 77% survival to discharge with 99% native heart recovery

these are truly incredible numbers from an industry that is normally measuring survival benefits in the single digit increases…or not at all.

ABMD has a huge huge market to grow into, no real competition, and is quite profitable. They have been expensive for the entire time I have owned them (since 2015) and yet I have a CAGR of about 85% on those shares for a total return of about 550%. Their competitive position reminds me of ZS or AYX. A note, their revenue growth has “only” been around 30% but they have had incredible operating leverage leading to their earnings increasing rapidly.

-ethan

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I’ll second all of that. This was a sleeper stock until it wasn’t – I also bought in mid to late 2015 and just held it to see what might happen. My IRR% is also in the 68-85% range (annualized), which is incredible – it even overtook my 5x sized NVDA position, which is something!

Now that even more actual data is coming out, it’s hard not to be a proud of this “little company” doing really great things to allow people to, you know, be alive longer.

I continue to love Abiomed for their patient focus – the human element. It’s built into the company’s mission statement, and you can hear it in the earnings calls. It’s hard to see them screw that part up, and they have literally no competition at their level. Anyone who wants to compete is in for a decade of FDA and other approvals. Not to say no one is trying, but anyone who has tried so far has had to bow out.

I think this one keeps running long and strong.

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What’s so funny is that I knew this was going to happen and never invested in it… not sure why honestly. Anyone who puts these devices in on a regular basis could see what they were accomplishing without a clinical trial.

There is a competitor lurking though so don’t sleep on the stock. However, based upon what I have seen, the competitor’s product is probably at least a couple of years from availability in the US.

MC

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MC
I am in ABMD. Any reason to be cryptic about the “competitor lurking?” Are you somehow involved with them, or can you tell us more about them- name, quality of their products, etc.

Thanks
David

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What’s so funny is that I knew this was going to happen and never invested in it…

It’s not funny, doc. You’re my go-to guy for this one. I like my gurus to have skin in the game. :slight_smile: Even though it was 19% cheaper a week ago, looking at a 5-year chart tells me it’s still not a bad time to jump in.

http://schrts.co/bPAMHb

I must admit, I cut my large slice down to 5% when the price was, IMO, way out of line. I guess Mr Market agreed, as he gave it a nice haircut this year. The thing is, It’s still way, way up. I’m guessing that 95% of investors would be better off with a long-term 10% allocation to ABMD.

Heart disease isn’t going away any time soon.

Dan
long ABMD, maybe forever

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Heart disease isn’t going away any time soon.

RaptorD2

I view Abiomed as similar to Intuitive Surgical, in that I believe that it could take quite some time for competing solutions to ever develop.

Like I generally believe about most companies that stage a large first mover advantage in a area in which the company also has a large moat, such companies rarely get disrupted quickly by competitors battling in the companies main area of expertise…sort of like no company has ever caught Nvidia in making GPUs and no company likely will ever catch Nvidia in GPUs but the best disruptors never battle by trying to go over a moat, the best disruptors often attack with a completely new paradigm

The one paradigm that could change things drastically for Abiomed seems to me to be future genetic manipulation technologies. I believe it possible that heart disease might not only be detected but also corrected before it ever occurs anywhere from 10 to 30 years into the future. They seem to already be experimenting with ideas like that:

https://futurism.com/promising-gene-therapy-tried-living-hum…

I think such a disruption will probably take about as long to develop as legitimate competition for Abiomed, but I would still follow gene therapy type developments if I owned any medical device or drug company. I own Illumina for that reason because it forces me to pay attention to what might be occurring in the genetic arena. I have a feeling that what humans will eventually be able to do with gene manipulation and things like nanobots will either allow humans to live for 200+ years or it might destroy the human race and earth as we know it. Read this book Wool https://www.amazon.com/dp/B0071XO8RA/ref=dp-kindle-redirect?... Wool would be about a possible future if gene manipulation and nanobots goes wrong. The whole Silo series https://en.wikipedia.org/wiki/Silo_(series) would be a true horror novel, in my opinion, because it seems to be a sci-fi story that’s within the realm of actually being able to occur.

Starrob

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The competitor is the HeartMate PHP. Currently available in the EU but not the US. It has one major advantage over the Impella in that it can provide cardiac output up to 5L/min percutaneously. The Impella device that can provide that much flow has to be placed surgically for now. So the question then becomes how often do you need the 5 liters (for those unaware, 5L/min is normal cardiac output for an ~70 kilogram adult at rest)?

The disadvantage of the PHP is that it has a continuous driveline from the external pump to the device inside the heart. This caused fractures of the driveline in tortuous anatomies in the early iterations of the device. However, they now have an interwoven driveline that seems to have overcome this problem… hopefully.

I have not used the PHP obviously but I would love to have that option at our institution. I don’t know if it takes longer to put in or not and any other nuances that could make it a better or worse product. I can now put in an Impella CP in about 7 minutes… it’ll be hard for the PHP to beat that but if it gives me 35% more cardiac output, I’d definitely use it a lot.

MC

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The real reason I don’t invest much in the cardiac medical space is because of my own bias to what I like. Just because I like it and use it doesn’t mean all the other docs will. I fear I won’t recognize inherent problems or I’ll be more apt to catch the “falling knife.” You just can’t be too careful when you are in the space where you invest. A lot of danger there and so I never pulled the trigger. Same with Edwards which developed the future of aortic valve replacement and I knew it when I saw it. I’ve done ok though… AYX, NFLX, SQ, SHOP to name a few. Don’t cry for me.

Heart disease isn’t going away any time soon.

Truer words have not been spoken. The incidence of heart attacks has stabilized but the incidence of heart failure is quickly becoming an epidemic of the industrialized world.

MC

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The HeartMate was the one that was recalled due to some malfunction? If I remember correctly a trial of HeartMate vs. Impella (maybe a non inferiority comparison) was one of the perceived fears for ABMD a couple years ago that kept the stock in the $100 range, then it really took off when the study was halted due to a patient death. Have they reconfigured and tried to bring it back to market?

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“The competitor is the HeartMate PHP. Currently available in the EU but not the US. It has one major advantage over the Impella in that it can provide cardiac output up to 5L/min percutaneously.”

HeartMD,

No, not really. As a physician (not heart, hematology-oncology = blood diseases & cancer) I made it a point to study the competition thoroughly and reviewed all medical research of the Impella products and their presumed competition before deciding to buy ABMD shares.

  1. HeartMate PHP, originally a Thoratec company, has had trouble for quite a while. When I checked HM PHP originally, Thoratec’s employees’ glassdoor ratings were poor. Many complained about too many short cuts and insufficient time to work on their projects, one of them even called the HeartMate a POS. Thoratec was bought by St. Jude Medical to great fanfare but they in turn sold it to Abbott Laboratories. The much touted device was recalled as of February 9, 2017, and all patient recruitment has been suspended after 8 incidents of pump failure, it included one death and one patient in life-threatening trouble, http://www.startribune.com/abbott-labs-halts-use-of-heartmat….

  2. The Bundesinstitut für Arzneimittel und Medizinprodukte (German Federal Institute for Drugs and Medical Devices) published this Abbott recall notice on February 6, 2017: https://www.bfarm.de/SharedDocs/Kundeninfos/EN/01/2017/01190….

  3. Since June 11, 2015 the FDA clinical trial, Identifier: NCT02468778 (aka Shield II), has been suspended.. The suspension was last updated December 15, 2017. I wouldn’t be surprised if Abbott now uses the Impella for their stent procedures, https://clinicaltrials.gov/ct2/show/NCT02468778.

  4. While Thoratec still list HeartMate PHP’s Cardiac Output as 5L/min, Abbott lists it as 4L/min.

  5. Impella 2.5 numbers are between 3.6 and 4.2 L/min. I’d stick with Impella.

ABMD is under-appreciate and most “analyst” do a horribly superficial job. To do a good ANALysis you have to be an@l a classmate once explained to me when I moaned about an assignment. What people don’t seem to know is that Impella is a German invention, that the inventor works for ABMD and most of the Impella products at least last time I checked which was a couple of years ago, are made in Germany. Even now most of their technical research is still done in Germany were they recently acquired two companies, both private, where virtually nothing about them is publicly available, though I tried.

If there is enough interest in ABMD, let me know and I’ll do a post after doing some sleuthing to update my information. I would also talk to Ingrid Goldberg regarding their latest research and innovations, both in Germany. One of them was a pediatric version of the Impella (I vaguely remember a halt of that endeavor), the other an umbrella type construction which unfolds when in the heart (left ventricle) and provides higher cardiac output than the Impella 2.5.

im

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IM wrote: “If there is enough interest in ABMD, let me know and I’ll do a post after doing some sleuthing to update my information.”

I have a position, and would definitely appreciate any information that you might care to share. Thanks!

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imyoung
Even now most of their technical research is still done in Germany were they recently acquired two companies, both private, where virtually nothing about them is publicly available, though I tried.

If there is enough interest in ABMD, let me know and I’ll do a post after doing some sleuthing to update my information. I would also talk to Ingrid Goldberg regarding their latest research and innovations, both in Germany.

Hands down, the best in depth, hands on, analysis I’ve read in a very long time. Especially useful are all the nuggets of the German inventors, compet info, the mergers, etc.

My ABMD plunge was July this year, full 10% position in the port. Bought on the one-day drop of -16% on 7/26. Continued to decline for a few days, now doing quite nicely, thank you very much.

Definitely interested in seeing any future ABMD info you may care to share. Tnx.

BB

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Ditto – ABMD is my second-largest position (after NVDA which has obviously grown tremendously), so would appreciate any and all info. Even if it duplicates some or all I’ve learned along the way, it will probably help someone else.

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I got into ABMD back in the $70 range, but then sold it after a near double in less than a year, as that was the time when there was a lot of talk about a competitor that was going to hurt ABMD. I got out and didn’t look back, not really regretting the decision, but may look at it again with the info from these most recent discussions.

Yes, those were the driveline issues (fractures) I mentioned. They seem to have resolved them due to the 8 or 10 different drivelines that are interwoven to make it more flexible and less apt to sheer stress.

MC

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im,

I know all of that information you posted. Great post by the way. You clearly have more time than I’ve had lately. However, a couple of things to clear up really quick that are wrong in your post.

Where did you find those numbers? You CANNOT get 4.2 L/min with an Impella 2.5… that is horse #$%^. I’ve never seen the 2.5 deliver over 3.2-3.3 on a consistent basis. I have no idea how/why that is being touted, it’s just not true. The Impella CP can’t even deliver 4.2 but I’ve seen it get to 3.8-3.9 on a couple of occasions. I have put in over 150 of these in the last 2 years. So, I’m not sure where those numbers come from but it does not reflect reality. If they could do that regularly then why make the 5.0 at all? Also, it’s not like you just put the Impella in and turn her up to max output. You have to gradually go up and some patients have a limit on the power levels at around 4 or 5 and they will get 2.2L/min and no more. Others will develop hemolysis at higher power levels limiting it for them. I’ve seen all of these issues and others. So just spouting numbers is disingenuous by any of the companies. That is MAX output and sometimes in vitro numbers are quoted and just don’t happen in the real world.

There is a difference in what Abbott can say the PHP can deliver and what it cannot say vs. what it can do. Look at the raw data for the device. At higher outputs it can deliver over 5. The article you cited above is getting nearly two years old. I have it on pretty high authority that the driveline issues the PHP suffered from have been resolved. This is from a leading expert in the field. Take that for what it’s worth but you’re citing an article that will be 2 years old soon. In the cardiac tech field that is an eternity.

All that to say, I love the Impella but do not sleep on the PHP. You seem to dismiss it as irrelevant and it won’t be.

MC

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Everyone-thanks for all of the great ABMD posts. I wouldn’t know a heart valve from a heart stent from my elbow. But, on the Abbott website, they discuss Heartmate 2 and 3 and they are in use. Is this different from PHP? They certainly have a lot going on. I am going to have a closer look. Maybe good idea to own both ABT and ABMD.

Just a quick blurb on ABT from my Morningstar subscription. ABT stock has not exactly knocked the cover off the ball over the last 15 years and has underperformed the med device sector even over last 5. Also is expensive compared to historical. But, maybe now it is worth the premium?
David

Tree,

Heartmates are surgically implanted. PHP is percutaneously placed. Huge difference.

MC

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Ok. Then I couldn’t find anything recent on Google suggesting the PHP halt had been lifted.