The exponential growth of data in healthcare and financial sectors presents unique challenges in storage, processing, and real-time analytics. High-velocity data streams—originating from electronic health records (EHRs), IoT medical devices, stock trading systems, and payment networks require sophisticated frameworks capable of handling large volumes with minimal latency. SAP HANA, an in-memory, columnar database platform, offers real-time processing capabilities that allow organizations to integrate advanced analytics and machine learning (ML) directly into transactional and operational data environments. By leveraging AI and ML, healthcare institutions can predict patient outcomes, optimize treatment plans, and enhance diagnostic accuracy, while financial organizations can detect fraud, assess risk, and execute high-frequency trading strategies efficiently. This review article explores the convergence of AI/ML techniques with SAP HANA for high-velocity data analytics, emphasizing both technical implementation and domain-specific applications. We provide an overview of SAP HANA’s architecture, predictive analytics libraries, and integration approaches with external ML frameworks such as Python, R, TensorFlow, and PyTorch. The article also examines real-time data pipelines, model deployment strategies, and key challenges, including data privacy, scalability, and model interpretability. Case studies in healthcare demonstrate predictive modeling for patient management, disease diagnosis, and imaging analytics, while financial applications highlight fraud detection, real-time risk assessment, and market analytics. Furthermore, the review discusses benefits such as reduced latency, improved decision-making, and operational efficiency, alongside limitations that include heterogeneous data integration, regulatory compliance, and model transparency. Finally, future research directions are outlined, including deep learning integration, edge computing for real-time analytics, hybrid cloud deployments, and explainable AI methodologies. This review serves as a comprehensive resource for researchers, practitioners, and decision-makers seeking to understand the potential of AI and ML integration within SAP HANA for processing and analyzing high-velocity healthcare and financial data efficiently and effectively.