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The value of primary preventative therapies for cardiovascular disease (CVD) in older adults (age ≥75 years) is less certain than in younger patients. There is a lack of quality evidence in older adults due to underenrolment in pivotal trials. While aspirin is no longer recommended for routine use in primary prevention of CVD in older adults, statins may be efficacious. However, it is unclear which patient subgroups may benefit most, and guidelines differ between expert panels. Three relevant geriatric conditions (cognitive impairment, functional impairment and polypharmacy) may influence therapeutic decision making; for example, baseline frailty may affect statin efficacy, and some have advocated for deprescription in this scenario. Evidence regarding statins and incident functional decline are mixed, and vigilance for adverse effects is important, especially in the setting of polypharmacy. However, aspirin has not been shown to affect incident cognitive or functional decline, and its lack of efficacy extends to patients with baseline cognitive impairment or frailty. Ultimately, the utility of primary preventative therapies for CVD in older adults depends on potential lifetime benefit. Rather than basing treatment decisions on absolute risk alone, consideration of comorbidities, polypharmacy and life expectancy should play a significant role in decision making. Coronary calcium score and new tools for risk stratification validated in older adults that account for the competing risk of death may aid in evaluating potential benefits. Given the complexity of therapeutic decisions in this context, shared decision making provides an important framework.

With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility‐based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth‐CR) and evidence being generated in this field.

Wearable accelerometers, which continuously record physical activity metrics, are commonly used in mobile health-enabled cardiac rehabilitation (mHealth-CR). The association between adherence to accelerometer use during mHealth-CR and improvement in clinical outcomes, such as functional capacity, is understudied. The emergence of artificial intelligence (AI) technology provides novel opportunities to investigate accelerometry use patterns in relation to mHealth-CR outcomes. In this study, we sought to use an AI clustering framework to identify distinct behavioral phenotypes of adherence to accelerometer use. We then aimed to quantify the association of these adherence phenotypes with functional capacity improvements in older adults undergoing mHealth-CR. We analyzed data from the RESILIENT (Rehabilitation at Home Using Mobile Health in Older Adults After Hospitalization for Ischemic Heart Disease) trial, the largest randomized clinical study to date comparing mHealth-CR versus usual care in older adults (aged ≥65 years). Intervention arm participants were instructed to wear a Fitbit accelerometer for the 3-month study duration. Adherence to accelerometer use was quantified as overall adherence (percentage of days worn) via k-means clustering AI-derived measures and compared with changes in 6-minute walk distance (6-MWD), adjusted for demographic and clinical covariates. Among 271 participants with a mean age of 71 years (SD 8), of whom 198 (73%) were male, accelerometers were worn for an average of 76 days (95% confidence limits 73,78) over 3 months. Adjusted analyses showed a weak association between days of wear and improvement in 6-MWD, with every 30 additional days associated with an 11-meter improvement (P=.08). Our k-means clustering framework identified adherence phenotypes at two resolutions: low resolution (k=2 clusters) and high resolution (k=8 clusters). The consistently high adherence cluster trended toward a 24.6-meter improvement in 6-MWD compared to the low and declining adherence clusters (n=39; 95% CI 0.7-49.9; P=.06). The 8-cluster phenotyping revealed a richer set of adherence patterns, with the consistently high adherence cluster in this analysis having a 38.5-meter (95% CI 2.2-74.7; P=.04) improvement in 6-MWD than the low adherence cluster, as well as greater average daily steps over the 3-month intervention (mean 7518, SD 3415 vs mean 4800, SD 2920 steps; P=.008). A time-series AI clustering framework identified a range of behavioral phenotypes representing different degrees of adherence to accelerometer use. Regression analysis identified a weak association between the higher adherence phenotype and functional capacity improvement in older adults undergoing mHealth-CR. Our AI-derived accelerometry adherence phenotypes may offer a new approach to tailor mHealth-CR regimens to individual patients, potentially leading to better outcomes in this high-risk population. ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/study/NCT03978130. RR2-10.2196/32163.

Paleoclimate research has built a framework for Earth’s climate changes over the past 65 million years or even longer. However, our knowledge of weather-timescale extreme events (WEEs, also named paleoweather), which usually occur over several days or hours, under different climate regimes is almost blank because current paleoclimatic records rarely provide information with temporal resolution shorter than monthly scale. Here we show that giant clam shells (Tridacna spp.) from the tropical western Pacific have clear daily growth bands, and several 2-y-long (from January 29, 2012 to December 9, 2013) daily to hourly resolution biological and geochemical records, including daily growth rate, hourly elements/Ca ratios, and fluorescence intensity, were obtained. We found that the pulsed changes of these ultrahigh-resolution proxy records clearly matched with the typical instrumental WEEs, for example, tropical cyclones during the summerautumn and cold surges during the winter. When a tropical cyclone passes through or approaches the sampling site, the growth rate of Tridacna shell decreases abruptly due to the bad weather. Meanwhile, enhanced vertical mixing brings nutrient-enriched subsurface water to the surface, resulting in a high Fe/Ca ratio and strong fluorescence intensity (induced by phytoplankton bloom) in the shell. Our results demonstrate that Tridacna shell has the potential to be used as an ultrahigh- resolution archive for paleoweather reconstructions. The fossil shells living in different geological times can be built as a Geological Weather Station network to lengthen the modern instrumental data and investigate the WEEs under various climate conditions.

The Asian-Australian monsoon system (A-AuMS) is the most typical cross-equatorial monsoon system and thus inter-hemispheric comparison is essential to explore its dynamics. Although the evolution of Holocene Asian summer monsoon has been extensively studied, changes in Australian summer monsoon (AuSM) is less investigated due to the lack of identified high-resolution paleoclimate records. Here we obtain a 13.5 kyr AuSM record from lacustrine sediments in northeastern Australia. It suggests that the weakening of the AuSM during the early to middle Holocene was regulated by Northern Hemisphere high-latitude ice volume, while the strengthening of the AuSM during the middle to late Holocene was mainly controlled by increased Southern Hemisphere summer insolation. The combination of Asian and Australian monsoon records show that the coupling evolution of A-AuMS was dominated by the temperature gradient between two hemispheres, which involve the changes of the AMOC, Northern Hemisphere ice volumes and solar insolation in both hemispheres. The reconstructed Holocene Australian summer monsoon in this study, together with the Asian monsoon records, show that the coupling evolution of Holocene Asian-Australian monsoon was dominated by the thermal imbalance between two hemispheres.

Background Results from national surveys indicate that many older adults reported delayed medical care during the acute phase of the COVID-19 pandemic, yet few studies have used objective data to characterize healthcare utilization among vulnerable older adults in that period. In this study, we characterized healthcare utilization during the acute pandemic phase (March 7–October 6, 2020) and examined risk factors for total disruption of care among older adults with multiple chronic conditions (MCC) in New York City. Methods This retrospective cohort study used electronic health record data from NYC patients aged ≥ 50 years with a diagnosis of either hypertension or diabetes and at least one other chronic condition seen within six months prior to pandemic onset and after the acute pandemic period at one of several major academic medical centers contributing to the NYC INSIGHT clinical research network ( n =276,383). We characterized patients by baseline (pre-pandemic) health status using cutoffs of systolic blood pressure (SBP) < 140mmHg and hemoglobin A1C (HbA1c) < 8.0% as: controlled (below both cutoffs), moderately uncontrolled (below one), or poorly controlled (above both, SBP > 160, HbA1C > 9.0%). Patients were then assessed for total disruption versus some care during shutdown using recommended care schedules per baseline health status. We identified independent predictors for total disruption using logistic regression, including age, sex, race/ethnicity, baseline health status, neighborhood poverty, COVID infection, number of chronic conditions, and quartile of prior healthcare visits. Results Among patients, 52.9% were categorized as controlled at baseline, 31.4% moderately uncontrolled, and 15.7% poorly controlled. Patients with poor baseline control were more likely to be older, female, non-white and from higher poverty neighborhoods than controlled patients ( P  < 0.001). Having fewer pre-pandemic healthcare visits was associated with total disruption during the acute pandemic period (adjusted odds ratio [aOR], 8.61, 95% Confidence Interval [CI], 8.30-8.93, comparing lowest to highest quartile). Other predictors of total disruption included self-reported Asian race, and older age. Conclusions This study identified patient groups at elevated risk for care disruption. Targeted outreach strategies during crises using prior healthcare utilization patterns and disease management measures from disease registries may improve care continuity.

Land snails exhibit the potential for capturing synoptic‐scale precipitation events through the δ18O records of their shells (δ18Oshell), but the application is hindered by the absence of a practical methodology for tracking these events. Here, we developed a statistical methodology to track the synoptic‐scale precipitation events from daily resolved snail body fluid δ18O (δ18OBF) record. We further tested and verified our approach using daily resolved δ18Oshell records of modern Cathaica fasciola from the Chinese Loess Plateau (CLP). The reconstructed 3‐day‐timescale precipitation events frequencies using first derivations of δ18OBF and δ18Oshell shows strong agreement with instrumental data (>85% detection accuracy). The strong correlation between precipitation days in snail‐growing‐season and annual precipitation amounts across the CLP also permits the reconstruction of synoptical precipitation frequency for investigating the interannual variability of precipitation. Our study paves the avenue in paleoweather study, enabling quantitative reconstructions of past synoptic‐scale precipitation events. Plain Language Summary Reconstructing past weather variations from paleoclimate archives can expand instrumental record and reveal weather variability not apparent in current data. Land snails are highly responsive to environmental changes, and the oxygen isotopic composition of their shells (δ18Oshell) can provide valuable clues about the precipitations occurred on daily to weekly timescale. However, no method for quantitatively tracking precipitation events using these snail shells is developed yet, which has greatly restricted the past synoptic‐scale precipitation variation reconstructions. To address this, in situ secondary ion mass spectrometry (SIMS) determination was conducted on the modern land snail shells collected on the Chinese Loess Plateau (CLP), yielding daily resolved δ18Oshell records. Combining these with long‐term observations of snail body fluid δ18O (δ18OBF), we developed a novel statistical method to track the synoptic precipitation events in the SIMS δ18Oshell records. Our approach, which reconstructs the precipitation frequency on a 3‐day timescale, closely matches instrumental data, achieving over 85% detection rate. This method also enables the investigation of interannual precipitation variability, since the strong correlation between precipitation frequency in snail‐growing‐season and annual precipitation amounts across CLP. This work paths a new way in the paleoweather study, enabling quantitative reconstructions of past synoptic‐scale precipitation events using fossil snail shells. Key Points Daily δ18O variations in snail body fluids and shells are mainly driven by precipitation Synoptic‐precipitation frequency can be quantitively reconstructed by daily resolved snail shell δ18O Reconstructed synoptic‐precipitation frequency can reveal the interannual precipitation variability in the past

The trade winds cause strong upwelling in the eastern equatorial Pacific, and create the eastern Pacific Cold Tongue (EPCT) that has far‐reaching impacts on global climate. However, large discrepancies persist in quantifying 20th‐century EPCT sea surface temperature (SST) changes across different instrumental data sets. Here we synthesize four coral Sr/Ca‐SST records from the tropical central‐eastern Pacific to develop a Cold Tongue Index (CTI) reconstruction for 1887–1997. The coral CTI record shows a rapid 20th century warming of the EPCT, suggesting an underestimation of warming trends in instrumental CTI records. The decadal to multidecadal changes in reconstructed EPCT SST show an association with the Walker Circulation. Our reconstruction indicates that recent EPCT cooling during the global warming hiatus is not unusual in the context of the 20th century. Our results provide new evidence for 20th century EPCT SST changes and an observational constraint for predicting future tropical climate changes. Plain Language Summary The tropical Pacific exhibits an asymmetric pattern of sea surface temperatures (SST) along the equator, with a warm pool in the west and a cold tongue in the east. The Eastern Pacific Cold Tongue (EPCT) plays a crucial role in influencing global climate. To date, however, considerable disagreement persists about changes and causes of the EPCT SST over the 20th century due to the sparse instrumental observations before ∼1960. Here we synthesize published coral Sr/Ca‐SST records from the tropical central‐eastern Pacific to develop a coral Cold Tongue Index (CTIcoral) for the period 1887–1997. The CTIcoral record correlates significantly with instrumental data since 1960, and thus allows reliable assessment of 20th century EPCT SST changes. Our record exhibits a rapid 20th century warming trend of the EPCT, indicating an underestimation of warming trends in instrumental CTI records. The decadal to multidecadal changes in CTIcoral also show an association with the Walker Circulation. Comparing the magnitude of the 1992–2011 trend in instrumental CTI with our reconstruction reveals that recent EPCT cooling during the global warming hiatus is not anomalous in the context of 20th century. Our findings have implications for predicting future EPCT SST changes by offering a constraint for model simulations. Key Points Synthesizing coral Sr/Ca‐SST records yields robust estimates of 20th century warming trend in the eastern Pacific Cold Tongue (EPCT) A coral‐based reconstruction indicates an underestimation of 20th century EPCT warming trends in instrumental SST records Recent EPCT cooling during the global warming hiatus is not anomalous in the context of the 20th century