Cleerly vs Heartflow (2026)
The two names that define cardiovascular CT AI win on different terrain. Heartflow created the non invasive coronary physiology category and holds the recognition no competitor matches: FFRCT is supported by the ACC AHA Chest Pain Guideline, a materially higher bar than a clearance, sitting on the largest evidence base in this index at more than 600 peer reviewed publications and clinical use across 400,000 plus patients. Cleerly's distinction is the payment machinery: its plaque quantification underpins Category I CPT codes, multiple Medicare contractor coverage determinations, and commercial policies reported to span more than 86 million covered lives. Two cautions belong in the verdict. Heartflow's Plaque and RoadMap functions are cleared only in the US and four other countries, with Europe, the UK, Australia, Canada, and Japan limited to FFRCT and Planner. And when Nature Reviews Cardiology benchmarked eight cleared plaque systems head to head, the publication records that Heartflow was unable to provide the required analysis for inclusion. If your failure mode is guideline backed physiology, start with Heartflow. If your failure mode is getting plaque quantification reimbursed, start with Cleerly.
- Reimbursement is the deciding constraint: the technology underpins Category I CPT codes, multiple Medicare Administrative Contractor coverage determinations, and commercial payer policies reported to span more than 86 million covered lives.
- Plaque phenotyping is the clinical question: comprehensive quantification and characterization of atherosclerotic disease from non invasive coronary CT angiography, with the multicenter international CONFIRM2 registry in the evidence base.
- Willingness to be compared: Cleerly appears among the eight cleared systems benchmarked head to head in the Nature Reviews Cardiology QCI consensus statement, the direct comparison Heartflow's analysis is absent from.
- Guideline recognition is the bar: FFRCT is supported by the ACC AHA Chest Pain Guideline, a higher bar than a 510(k) clearance and one no competitor in this lane holds.
- Evidence depth without rival: more than 600 peer reviewed publications, over 100 studies assessing more than 365,000 patients, and landmark work from SCOT HEART through the PRECISE trial to the DECIDE registry of roughly 22,000 patients.
- One platform across the pathway: RoadMap stenosis detection, FFRCT physiology, Plaque quantification, and Planner for intervention, four functions under Heartflow One in cleared markets.
This comparison is published by AI Health Index, an independent research platform that compares healthcare AI vendors objectively. Cleerly and Heartflow are each graded against the same capability taxonomy, from each vendor's own public materials and the regulatory record, under the AI Health Index verification standard. No vendor pays for placement, and no vendor has reviewed this page. How this evidence is graded
Plain facts
| Fact | Cleerly | Heartflow |
|---|---|---|
| Primary category | Radiology & Imaging AI | Radiology & Imaging AI |
| Founded | 2017 | 2007 |
| Headquarters | Denver, Colorado, United States | Mountain View, California, United States |
| Website | cleerlyhealth.com | heartflow.com |
Side by Side
Each record in one paragraph
Written to be quoted whole. Each paragraph states what the AI Health Index verified about the vendor, with the caveats attached. Generated from this pair’s live capability grades, so it moves when a grade moves.
The AI Health Index awards Cleerly its top capability grade on several axes, including AI Centrality, Clinical and Operational Evidence and Security Certifications and Trust Center. Set against Heartflow, Cleerly grades higher on AI Governance and Bias Disclosure and AI Liability and Recourse. Grades reflect evidence the AI Health Index could verify at the last review, so a low grade records disclosure the vendor has not published rather than a capability it has been shown to lack.
Source: AI Health Index, July 2026
The AI Health Index awards Heartflow its top capability grade on several axes, including AI Centrality, Clinical and Operational Evidence and Security Certifications and Trust Center. Set against Cleerly, Heartflow grades higher on several axes, including Model Supply Chain Disclosure, AI Safety and PHI Stewardship and EHR and Interoperability Depth. Grades reflect evidence the AI Health Index could verify at the last review, so a low grade records disclosure the vendor has not published rather than a capability it has been shown to lack.
Source: AI Health Index, July 2026
Questions buyers ask
Should we choose Cleerly or Heartflow?
On the axes where the AI Health Index separates them, Cleerly grades higher on AI Governance and Bias Disclosure and AI Liability and Recourse, and Heartflow grades higher on several axes, including Model Supply Chain Disclosure, AI Safety and PHI Stewardship and EHR and Interoperability Depth. Heartflow leads on the greater share of scored axes, but the split means the decision turns on which constraint is binding rather than on an overall winner.
Where do Cleerly and Heartflow differ most?
The widest separation the AI Health Index records between Cleerly and Heartflow is on AI Governance and Bias Disclosure, where Cleerly grades B and Heartflow grades C. That axis sits in the Regulatory and Compliance group, so it should carry the most weight for a buyer whose binding constraint is where regulatory exposure sits and who carries it.
Where do Cleerly and Heartflow grade the same?
The AI Health Index grades Cleerly and Heartflow the same on several axes, including AI Centrality, Autonomy and Oversight Model and Model and Technology Transparency. Neither holds an advantage the index can evidence on those axes, so they should not carry weight in a selection between these two.
Related comparisons
Other published head to head assessments involving these vendors or their closest peers. The full set for this category is on the Clinical Decision Support page.
Publication and patient counts are drawn from Heartflow's own evidence dossier and Cleerly's published materials; this index has not re verified the underlying studies. Regulatory scoping is critical and split: all four Heartflow functions are cleared in the US, Bahrain, Israel, Saudi Arabia, and the UAE, while Europe, the UK, Australia, Canada, and Japan are limited to FFRCT and Planner.
Buyers should verify Cleerly's clearance status in their own market directly, as this record does not enumerate it. Neither vendor publishes pricing; the Category I CPT for automated plaque analysis, reported at US$950 per assessment from January 2026, is set by the payer system rather than either vendor.