Résumé
Pneumococcal vaccination rates are very low among high-risk patients, particularly those with heart failure (HF). This population is exposed to a high risk of severe infections and numerous complications that could be prevented by vaccination. That is why a prospective interventional trial was designed to evaluate the impact of an incentive campaign carried out by the French health insurance. This study was an open-label randomized controlled trial involving physicians and theirs related patients with chronic HF, identified through the ERASME health insurance database. Data were routinely collected using this database to conduct the study. In the intervention group, both physicians and their patients received two vaccination incentive letters, whereas the control group was only observed. The primary endpoint was the vaccination rate at one year. 3,927 physicians and 12,077 corresponding patients with HF were analyzed. The pneumococcal vaccination rate at one year was 35% in the intervention group versus 3.5% in the control group. Multivariate analyses showed a 15-fold higher probability of vaccination in patients receiving a letter. Factors associated with vaccination included patient age (less receptive <70 years and >85 years), gender (male patients and female doctors more receptive) and previous influenza vaccination. This randomized study demonstrates the effectiveness of a mail-in promotion to sustainably increase pneumococcal vaccination coverage in a frail high-risk population. Further analyses are in progress to evaluate the impact on clinical events.