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Outcomes and process of care for acute myocardial infarction (AMI) may vary by sociodemographic status. In particular, both low income and uninsured status are common among patients cared for by the nation's safety net hospitals. These characteristics have been linked with delays in seeking care for an AMI. However, less is known about the characteristics and risk factor control among vulnerable patients prior to their index event. Given this background, we assessed cardiac risk factor control before admission, and evidence-based medical care at discharge, following an index AMI event within an urban safety net hospital. Prior to hospitalization, 25% of patients were not integrated into our safety net system and had suboptimal risk factor control. Despite this, inhospital conformity with AMI performance measures were excellent, with 95% of eligible patients receiving a composite criterion of aspirin and β-blockers on admission and discharge. A majority of AMI survivors were successfully integrated into our system postdischarge.