Background: Acute heart disease is among the ten most common non-communicable diseases in Indonesia. Diagnosis of acute heart disease is commonly confirmed using electrocardiography (ECG) or troponin measurement; however, these diagnostic tools are not available in all healthcare facilities. The Neutrophil-to-Lymphocyte Ratio (NLR) is a readily accessible laboratory parameter that can be assessed in patients presenting with chest pain. Purpose: This study aimed to determine the relationship between NLR and High-Sensitivity Troponin I (hs-TnI) levels in patients with acute heart disease who need rapid treatment. Method: This descriptive quantitative study used secondary data obtained from Husada Utama Hospital, Surabaya, covering the period from January 2023 to March 2024. A total of 52 patient records that met the inclusion criteria were analyzed. Statistical analysis was performed using the Spearman correlation test. Result: The findings of this study demonstrated a positive correlation between NLR and hs-TnI levels in patients with acute heart disease at RSUD Husada Utama Surabaya, indicating that an increase in troponin I levels was accompanied by an increase in NLR levels. The majority of patients with acute heart disease are 16 men with a range of ages 46 - 55 years. Data analysis using the Spearman test obtained a correlation coefficient of 0.279, indicating the level of strength of the relationship between variables and a significance value of 0.045 <0.05. Conclusion: There is a significant correlation between NLR and hs-TnI levels in acute heart disease at Husada Utama Hospital, Surabaya.