Community pharmacy as the main vaccinator in remotely monitored heart failure patients: sex- and age-related differences in vaccination pathways

Background Vaccination is a key preventive intervention in heart failure (HF), but uptake and delivery pathways remain heterogeneous. In France, expanded pharmacy-based vaccination may improve access, yet its role in HF care pathways is not well described. Knowing who administers vaccines can inform scalable, telemonitoring-enabled strategies. Methods Cross-sectional survey of HF patients enrolled in the Satelia® Cardio remote monitoring programme in France (November 2025). Participants self-reported vaccination status for seasonal influenza and seasonal COVID-19 booster (this season), pneumococcal, DTPC booster, and herpes zoster, and, if vaccinated, the vaccinator category (pharmacy, GP, nurse, specialist, centre, hospital/clinic, other). Distributions were described per vaccine; sex- and age-group differences were tested with χ² among vaccinated respondents. Results Among 1,100 respondents (mean age 71.5 years; 65.3% men), 684 reported influenza vaccination this season, 345 the seasonal COVID-19 booster, 379 pneumococcal vaccination, 424 DTPC booster, and 127 herpes zoster vaccination. Community pharmacy was the dominant vaccinator for influenza (66.4%), COVID-19 booster (81.2%), pneumococcal vaccination (43.0%), and herpes zoster (59.1%), whereas DTPC boosters were mainly delivered by GPs (54.2%). Vaccination centres and hospitals/clinics contributed minimally. Vaccinator distributions differed by sex for influenza (p=0.032) and COVID-19 booster (p=0.007): GP delivery was more frequent in women than men (influenza 11.9% vs 5.6%; COVID-19 booster 9.3% vs 1.7%), while pharmacy delivery was more frequent in men (influenza 68.9% vs 62.1%; COVID-19 booster 85.2% vs 73.1%). For influenza, pathways varied with age (p<0.001), whereas COVID-19 booster pathways did not (p=0.358). Vaccinator data were complete among vaccinated respondents. Conclusions Community pharmacies are central delivery partners for adult vaccination in telemonitored HF, while DTPC remains GP-led. Remote monitoring could operationalize pathway-specific prompts (pharmacy-focused for influenza/COVID-19 and pneumococcal; GP-focused for DTPC), standardize education, and facilitate shared documentation between pharmacies and primary care. Sex- and age-patterns indicate that tailoring the point-of-care recommendation may improve reach. Findings rely on self-report and should be confirmed against vaccination records and linked to clinical outcomes. These insights can guide regional partnerships and reminder workflows within HF programmes.