Regional heterogeneity in adult vaccination uptake among remotely monitored heart failure patients in France: a cross-sectional survey

Heart failure (HF) patients are prioritized for several adult vaccines, but uptake may vary geographically because of differences in care pathways and local delivery. Remote monitoring programmes could support prevention by targeting areas with the largest gaps. We mapped vaccination knowledge and self-reported uptake across French official regions in a remotely monitored HF cohort.

Cross-sectional, self-administered survey among HF patients enrolled in the Satelia Cardio telemonitoring programme in France (November 2025). Participants reported vaccination knowledge/attitudes and self-reported status for seasonal influenza and COVID-19 booster (this season), pneumococcal, DTPC booster, and herpes zoster. Regional differences were assessed descriptively; adjusted heterogeneity was tested with logistic regression (region + age + sex; reference Île-de-France).

Among 1,100 respondents (mean age 71.5 years), 13 metropolitan/overseas regions had ≥10 participants (n=11–204). Overall, most participants considered vaccination useful (87.5%) and knew where to get vaccinated (96.0%). Influenza uptake ranged from 6.7% (Martinique) to 74.0% (Provence-Alpes-Côte d'Azur), and seasonal COVID-19 booster uptake from 6.7% (Martinique) to 42.1% (Centre-Val de Loire). Pneumococcal vaccination showed the widest variation, from 6.7% (Martinique) to 53.2% (Provence-Alpes-Côte d'Azur). DTPC booster coverage varied from 23.1% (La Réunion) to 48.8% (Normandie), whereas herpes zoster coverage remained low (min 0.0% in Martinique; max 16.3% in Normandie). After adjustment for age and sex, regional heterogeneity remained significant for influenza (p<0.001) and pneumococcal vaccination (p<0.001), and persisted for the seasonal COVID-19 booster (p=0.023).

In remotely monitored HF patients, vaccination uptake varied substantially across official French regions, particularly for pneumococcal vaccination and the seasonal COVID-19 booster. These findings support geographically and age/sex-tailored preventive strategies within telemonitoring programmes, prioritizing regions with the lowest uptake for proactive reminders and coordination with primary care and community pharmacies. Overseas regions represented small but informative samples and consistently fell in the lowest ranges for several vaccines. Embedding region-aware dashboards and automated outreach in telemonitoring could help close gaps while standardizing vaccine education during routine HF follow-up. Clinical outcome links merit prospective evaluation.