Age-adjusted sex differences in pneumococcal vaccination uptake in remotely monitored heart failure: a cross-sectional survey

Background Heart failure (HF) patients are prioritized for multiple adult vaccines, yet coverage remains suboptimal. Sex-related differences in preventive care utilization and vaccination delivery pathways may contribute to persistent gaps. Remote monitoring programmes may offer scalable platforms to support personalized reminders and coordination across vaccinators. We assessed sex-specific patterns in vaccination uptake, knowledge, and delivery pathways in remotely monitored HF patients. Methods In November 2025, we performed a cross-sectional, self-administered survey among HF patients enrolled in the Satelia® Cardio remote monitoring programme in France. Participants reported vaccination knowledge and attitudes and self-reported status for five vaccines: seasonal influenza (this season), seasonal COVID-19 booster (this season), pneumococcal, diphtheria–tetanus–polio–pertussis booster (DTPC), and herpes zoster. Women and men were compared using χ² tests; age-adjusted odds ratios (aOR) were estimated with logistic regression. Results Among 1,100 respondents (mean age 71.5 years), 379 were women (34.5%) and 718 men (65.3%) (sex not specified: 3). Vaccination was considered useful by 88.4% of women and 87.2% of men, and 96.0% in both sexes reported knowing where to get vaccinated. Willingness to receive reminders from Satelia or the care team was similar (54.1% in women vs 55.8% in men). If vaccination was recommended by their physician, 78.1% of women and 81.3% of men reported they would get vaccinated (unsure: 17.7% vs 14.1%; no: 4.2% vs 4.6%). Influenza uptake was similar by sex (62.0% women vs 62.3% men). Pneumococcal vaccination was higher in women (42.2% vs 30.4%; p<0.001) and remained significant after age adjustment (aOR 1.67, p<0.001). DTPC coverage did not differ (40.1% vs 37.6%). Women tended to report higher herpes zoster vaccination (14.0% vs 10.2%; aOR 1.42, p=0.073) and lower seasonal COVID-19 booster uptake (28.5% vs 32.9%; aOR 0.79, p=0.093). Delivery pathways differed modestly: men more frequently reported pharmacy vaccination for influenza and COVID-19, whereas women more often reported general practitioner vaccination (both p<0.05). Conclusions In remotely monitored HF patients, pneumococcal vaccination uptake was substantially higher in women than men after age adjustment, while influenza uptake was similar. Sex differences in delivery pathways suggest that remote monitoring-enabled strategies may benefit from tailoring outreach and coordination across community pharmacies and primary care to reduce remaining gaps.