Biomedical applications often require classifiers that are both accurate and cheap to implement. Today, deep neural networks achieve the state-of-the-art accuracy in most learning tasks that involve large data sets of unstructured data. However, the application of deep learning techniques may not be beneficial in problems with limited training sets and computational resources, or under domain-specific test time constraints. Among other algorithms, ensembles of decision trees, particularly the gradient boosted models have recently been very successful in machine learning competitions. Here, we propose an efficient hardware architecture to implement gradient boosted trees in applications under stringent power, area, and delay constraints, such as medical devices. Specifically, we introduce the concepts of asynchronous tree operation and sequential feature extraction to achieve an unprecedented energy and area efficiency. The proposed architecture is evaluated in automated seizure detection for epilepsy, using 3074 h of intracranial EEG data from 26 patients with 393 seizures. Average F1 scores of 99.23% and 87.86% are achieved for random and block-wise splitting of data into train/test sets, respectively, with an average detection latency of 1.1 s. The proposed classifier is fabricated in a 65-nm TSMC process, consuming 41.2 nJ/class in a total area of 540 × 1850 μm 2 . This design improves the stateof-the-art by 27× reduction in energy-area-latency product. Moreover, the proposed gradient-boosting architecture offers the flexibility to accommodate variable tree counts specific to each patient, to trade the predictive accuracy with energy. This patient-specific and energy-quality scalable classifier holds great promise for low-power sensor data classification in biomedical applications.