Influenza infection is associated with accelerated atherogenesis and enhanced acute myocardial infarction (AMI) risk.1–3 Influenza vaccination in patients with recent AMI reduces the risk of major adverse cardiac events;1,4 routine vaccination now carries a Class IA recommendation following AMI in the most recent European Society of Cardiology guidelines.5 Strategies to improve vaccination rates in this high-risk cohort are needed. In this secondary analysis of NUDGE-FLU, we evaluated the effects of electronic letters vs. usual care on vaccination rates among those with AMI.