Vaccination delivery pathways in remotely monitored heart failure: community pharmacy predominance with sex- and age-related differences

Background Vaccination is a key preventive intervention in heart failure (HF), yet both uptake and delivery pathways remain heterogeneous. In France, expanded pharmacy-based vaccination may improve access, but its contribution to HF preventive care pathways is not well characterized. Understanding “who vaccinates” can inform scalable, telemonitoring-enabled implementation strategies. Methods We conducted a cross-sectional survey among 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 vaccination, diphtheria–tetanus–polio–pertussis booster (DTPC), and herpes zoster vaccination. For each vaccine received, respondents reported the vaccinator category (community pharmacy, general practitioner [GP], nurse, specialist, vaccination centre, hospital/clinic, other). Distributions were described by vaccine; sex- and age-group differences were tested using 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 accounted for most influenza (66.4%) and COVID-19 booster vaccinations (81.2%) and represented a major delivery channel for pneumococcal (43.0%) and herpes zoster vaccination (59.1%), whereas DTPC boosters were predominantly GP-delivered (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, delivery pathways varied significantly with age (p<0.001), whereas COVID-19 booster pathways did not (p=0.358). Vaccinator data were complete among vaccinated respondents. Conclusions In remotely monitored HF patients, community pharmacies were the predominant delivery channel for several adult vaccines, while DTPC boosters remained primarily GP-led. These pathway-specific patterns, including sex- and age-related differences, support tailoring remote monitoring-enabled interventions (e.g., pharmacy-focused prompts for influenza/COVID-19 and pneumococcal vaccination, and GP-centred prompts for DTPC), coupled with standardized education and improved documentation across providers. Findings are self-reported and should be confirmed against vaccination records and linked to clinical outcomes.